Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers [article]

Background: Gambling disorder is related to high overall gambling engagement; however specific activities and modalities are thought to have stronger relationships with gambling problems. This study aimed to isolate the relationship between specific gambling activities and modalities (Internet and venue/land-based) to gambling disorder and general psychological distress. Past-month Internet gamblers were the focus of this investigation because this modality may be associated with gambling disorders in a unique way that needs to be separated from overall gambling intensity.

Methods: Australians who had gambled online in the prior 30 days (N = 998, 57% male) were recruited through a market research company to complete an online survey measuring self-reported gambling participation, problem gambling severity, and psychological distress.

Results: When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines (EGMs) and venue-based sports betting. Psychological distress was uniquely associated with higher frequency of venue gambling using EGMs, sports betting, and casino card/table games.

Conclusions: This study advances our understanding of how specific gambling activities are associated with disordered gambling and psychological distress in users of Internet gambling services. Our results suggest that among Internet gamblers, online and land-based EGMs are strongly associated with gambling disorder severity. High overall gambling engagement is an important predictor of gambling-related harms, nonetheless, venue-based EGMs, sports betting and casinos warrant specific attention to address gambling-related harms and psychological distress among gamblers.
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Citation: Gainsbury, S.M., Angus, D.J. & Blaszczynski, A. (2019). Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers. BMC Public Health, 19(1372). DOI:

The density of electronic gambling machines and area-level socioeconomic status in Finland: a country with a legal monopoly on gambling and a decentralised system of EGMs [open-access article].

Background: Electronic gambling machines (EGMs) are considered a risky form of gambling. Internationally, studies have reported that the density of EGMs tends to be higher in socioeconomically disadvantaged areas than in more advantaged ones. We examined whether this holds true in the Finnish context where a decentralised system of EGMs guarantees wide accessibility to this form of gambling. More precisely, we investigated the association between the density of EGMs and area-level socio-economic status (SES).

Methods: The primary measure was the EGM density, referring to the number of EGMs per 1000 adults. The area-level SES was defined on the basis of the median income of inhabitants, the proportion of unemployment in the area and educational attainment (% of those beyond primary education). Three additional area characteristics were used as control variables in the analyses; the overall population density, economic activity (the number of jobs in the area per employed inhabitant), and the mean age of the inhabitants. Analyses were based on linear regression.

Results: The EGM density was 3.68 per 1000 inhabitants (SD = 2.63). A lower area-level SES was correlated with a higher EGM density. In further analyses, this effect was mostly explained by the income of the inhabitants. Of the control variables, the population density had no detectable effect on the EGM density while areas with a higher mean age of the inhabitants, as well a higher density of jobs, had more EGMs.

Conclusions: EGMs are unequally located in Finland, with more EGMs located in socio-economically less advantaged areas. The higher machine density in areas of social disadvantage is not in line with the aim of the Finnish gambling policy, which is to prevent and reduce harm caused by gambling. Changes in policy are required, especially with regard to the decisions on the placement of EGMs. This should not be made solely by gaming operators and/or from fiscal perspectives. Article available online

Citation: Raisamo, S., Toikka, A., Selin, J., & Heiskanen, M. (2019) The density of electronic gambling machines and area-level socioeconomic status in Finland: a country with a legal monopoly on gambling and a decentralised system of EGMs. BMC Public Health, 19(1198). Retrieved from

Public health effects of gambling – debate on a conceptual model [open-access article].

Background: Gambling for money is a popular leisure time activity in most countries, which has major social and economic impacts not only affecting the gambler, but his/her significant others, and the society. Gambling impact studies can help researchers and policymakers compare the health and social costs and benefits of different gambling policies and can be used when considering which gambling policies will reduce or increase costs or benefits the most. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity. Although some studies have created basic principles for conducting impact studies, a theoretical model is currently lacking. The aim of this debate is to review complementing and contrasting views on the effects of gambling to create a conceptual model, where a public health perspective is applied.

Main text: The effects of gambling can be structuralized using a conceptual model, where impacts are divided into negative and positive; costs and benefits. Costs and benefits are categorized into three classes: financial, labor and health, and well-being. These classes manifest in personal, interpersonal, and societal levels. Individual impacts cause effects on a personal level to gamblers themselves. External impacts influence the interpersonal and society/community levels and concern other people. The temporal level refers to the development, severity and scope of the gambling impact. These include general impacts, impacts of problem gambling and long-term impacts of gambling.

Conclusions: The conceptual model offers a base on which to start building common methodology for assessing the impact of gambling on the society. While measuring monetary impacts is not always straightforward, the main issue is how to measure the social impacts, which are typically ignored in calculations, as are personal and interpersonal impacts. The reviewed empirical work largely concentrated on the costs of gambling, especially costs on the community level. The Model can be used to identify areas where research is scarce. Filling the gaps in knowledge is essential in forming a balanced evidence base on the impacts of gambling. Ideally, this evidence could be the starting point in formulating public policies on gambling. Article available online

Citation: Tiina Latvala, T., Lintonen, T., & Konu, A. (2019). Public health effects of gambling – debate on a conceptual model. BMC Public Health, 19(1077). doi:

The impact of pop-up warning messages of losses on expenditure in a simulated game of online roulette: a pilot study [open-access article].

‘Pop-up’ warning messages have potential as a Responsible Gambling tool, but many warning messages in the literature are generic. The present study simulated digital roulette to compare the effectiveness of expenditure-specific, generic and control messages, during online roulette.

Forty-five casual gamblers participated in a laboratory setting. Gambles were ‘rigged’ such that participants suffered a net loss. Total ‘play money’ wagers from individual bets after the presentation of the messages were measured.

Expenditure-specific warning messages demonstrated significant reductions in wager amounts compared with other message types – Generic (p = .035) and Control messages (p < .001). No significant differences were found between Generic and Control messages (p > .05). Thus expenditure-specific warning messages about current losses were more effective than generic messages for reducing expenditure.

Expenditure-specific warning messages exhibit potential for ameliorating potentially harmful gambling behaviour. Expenditure-specific messages should be tested in a broader range of gambling contexts to examine their generalizability and potential for implementation in the gambling industry. Article available online

Reference: McGivern, P., et al. (2019). The impact of pop-up warning messages of losses on expenditure in a simulated game of online roulette: a pilot study. BMC Public Health 19:822.

Evaluating changes in electronic gambling machine policy on user losses in an Australian jurisdiction [open-access article].

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. Access online article

Reference: Stevens, M. & Livingstone, C. (2019). Evaluating changes in electronic gambling machine policy on user losses in an Australian jurisdiction. BMC Public Health, 19(517). Retrieved from

The use of self-management strategies for problem gambling: A scoping review [open-access article]

Background: Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern.

Methods: We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool.

Results: We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness.

Conclusions: Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment. Article available online

Reference: Matheson, F.L. et al. (2019). The use of self-management strategies for problem gambling: A scoping review. BMC Public Health, 19:445

The importance of friends and family to recreational gambling, at-risk gambling, and problem gambling [open access article]

Mazar et al. (2018). BMC Public Health 18(1080)

Background: The variables correlated with problem gambling are routinely assessed and fairly well established. However, problem gamblers were all ‘at-risk’ and ‘recreational’ gamblers at some point. Thus, it is instructive from a prevention perspective to also understand the variables which discriminate between recreational gambling and at-risk gambling and whether they are similar or different to the ones correlated with problem gambling. This is the purpose of the present study.

Method: Between September 2013 to May 2014, a representative sample of 9,523 Massachusetts adults was administered a comprehensive survey of their past year gambling behavior and problem gambling symptomatology. Based on responses to the Problem and Pathological Gambling Measure, respondents were categorized as Non-Gamblers (2,523), Recreational Gamblers (6,271), At-Risk Gamblers (600), or Problem/Pathological Gamblers (129). With the reference category of Recreational Gambler, a series of binary logistic regressions were conducted to identify the demographic, health, and gambling related variables that differentiated Recreational Gamblers from Non-Gamblers, At-Risk-Gamblers, and Problem/Pathological Gamblers. Access full article