Mr Paul Marden  and Ms Rosa Billi Office of Gaming and  Racing Research
Victorian Longitudinal Study -overview and early outcomes Rosa Billi and Paul Marden Responsible Gambling Awareness Week M...
Presentation Overview <ul><li>Public Health Approach </li></ul><ul><li>Background </li></ul><ul><li>Methodology </li></ul>...
What is a public health approach? <ul><li>Public Health approach </li></ul><ul><ul><li>prevention, intervention, treatment...
What is a public health approach? <ul><li>Prevalence </li></ul><ul><ul><li>the number of instances of a given disease or c...
Background <ul><li>Major aims : </li></ul><ul><ul><li>Explore the causal pathways to, and from, problem gambling </li></ul...
Background <ul><li>Key hypotheses guiding research: </li></ul><ul><ul><li>Gamblers with moderate risk CPGI scores are cons...
Background <ul><li>Four waves </li></ul><ul><li>Wave Timing N </li></ul><ul><li>One July- Oct 2008 15000 </li></ul><ul><li...
Methodology <ul><li>Wave One Epidemiology Baseline </li></ul><ul><li>Vic adult population 18+ </li></ul><ul><li>Sample of ...
Methodology <ul><li>PGSI </li></ul><ul><ul><li>a nine question scored index, the validated  Problem Gambling Severity Inde...
Methodology <ul><li>Wave One- the following were asked: </li></ul><ul><li>PGSI  Kessler 10 </li></ul><ul><li>Self reported...
Methodology <ul><li>Wave Two CATI </li></ul><ul><li>Core questions  Additional contextual questions- </li></ul><ul><ul><li...
Methodology-Qualitative <ul><li>Qualitative  </li></ul><ul><li>In-depth, face to face interviews, one-on-one </li></ul><ul...
Methodology <ul><li>Maintaining Contact </li></ul><ul><li>communications/media  </li></ul><ul><li>www.gamblingstudy.com.au...
Findings-Wave Two Participation in  W2 based on the PGSI status in W1 PGSI  Risk segment Agreed to participation Wave 1 (n...
Findings-Wave Two <ul><li>Gender of the Wave Two sample (n=5003)  </li></ul>
Findings-Wave Two <ul><li>The four most popular gambling activities for all Wave Two participants were: </li></ul><ul><li>...
Findings-Wave Two <ul><li>Amongst  problem gamblers : </li></ul><ul><li>95.6 per cent played electronic gaming machines in...
Findings-Wave Two Gamblers within PGSI segments who gamble alone, with one other person or in groups
Findings-Wave Two <ul><li>Self-reported depression and anxiety </li></ul><ul><li>Over a half (51 per cent) of problem gamb...
Findings-Wave Two K10 psychological distress scale
Findings-Wave Two <ul><li>Self-reported smoking </li></ul><ul><li>Participants in both waves were asked questions regardin...
Findings-Wave Two Self reported smoking in past twelve months
Findings-Wave Two <ul><li>Life Events </li></ul><ul><li>Problem gamblers reported higher rates of several life events.  </...
Findings-Wave Two <ul><li>Social Capital </li></ul><ul><li>Approximately 85 per cent of gamblers across all PGSI risk segm...
Findings-Wave Two <ul><li>Social capital </li></ul><ul><li>Less than 45 per cent of problem gamblers reported that they co...
Findings Transitions W1-W2 Wave Two Completed 2009 NG NPG LR MR PG TOTAL Shifted W1 to W2 NG 1024 464 526 24 9 1 560 Wave ...
Findings Transitions W1- W2 <ul><li>Stability and Change </li></ul><ul><li>5.6 % of gamblers increased their risk segment ...
Findings Transitions W1-W2 <ul><li>Incidence (new cases) </li></ul><ul><li>12 month incidence rate -  0.36% </li></ul><ul>...
Trends and longitudinal studies <ul><li>You need more than one follow up (that is, wave two) to be definitive as to the fa...
What were associated factors with wave two increasing risk? <ul><li>Those who have poor general and psychological health <...
BUT...we have to be careful jumping to conclusions… <ul><li>The measure for psychological distress ( Kessler 10) is associ...
What about those who moved into problem gambling in wave two? <ul><li>Strongest predictors of this movement are: people wh...
What of those who moved in moderate risk category? <ul><li>Interestingly the factors that were associated with people who ...
If we group problem and moderate risk gamblers together …. <ul><li>Between wave one and wave two, those who moved into eit...
Factor associated with decreasing risk… <ul><li>No factors were found to be statistically significant for those moving out...
<ul><li>The End ...   </li></ul><ul><li>If only…  more findings from the trend analysis will help us…stay tuned. </li></ul...
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Early outcomes from the (Study of Gambling in Victoria) longitudinal study, 2nd wave of results

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Mr Paul Marden and Ms Rosa Billi
Manager and Senior Project Officer,
Office of Gaming and Racing Research

Presentation given at:
The New Game: Emerging technology and responsible gambling

This forum was hosted by the Victorian Government's Office of Gaming and Racing on 23 May 2011, as part of Responsible Gambling Awareness Week.

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  • 7148 consented to further research 5003 completed surveys Ethics approval to approach soft refusals in wave one- there were 3339 soft refusals and 1145 completed w3 surveys. Soft refusals are people who indicated matters such as: they had to leave the telephone conversation (to look after pets, children) or that they were busy (in general). They did not give an outright NO nor hung up the phone. 320 completed w3 surveys from those who agreed to participate in wave one, but were not able to be contacted in wave two. Re Wave Four: 20% attrition (note for Paul) Wave four sample may approximate therefore 4400 to 4500.
  • Gambler defined as anyone who gambled once in the past year, including lotto Broad definition The wave one report is a stand-alone report on gambling in Victoria and had the largest sample ever in Victoria.
  • Victoria used a Queensland scoring version of the PGSI which has been used widely throughout Australia since 2001. The original answers to the nine PGSI questions ae : Never = 0; Sometimes = 1; most of the time = 2; Almost always = 3. The modified categories used in the epi study and in the longitudinal study are: Never = 0; Rarely = 1; Sometimes = 1; Often = 2; and Always = 3. In a discussion about the impact of the scoring change the Productivity Commission in its 2010 report ( Appendix D) stated that only a small percentage effect on PG estimate and a slightly effect (5%) on the MR estimate would result. In other words, it was fairly inconsequential to findings.
  • Paul: Why use CATI??? Still used in major surveys ( e.g. Department of Health). Mixed methods are increasingly popular but the ‘jury is out’ n how successfully these can be integrated to gain accurate population-based estimates.
  • External events such as the economic stimulus packaged of $12.2 billion to assist households designed to stimulate consumption affects results in any one year. Natural disasters such as the bushfires were recognised as having an effect on overall results. In wave three the focus shifted to recognising that the timing of the surveys (in part) coincided with the racing season. Further other gambling matters such as jackpots and first wins were added as experts recognised that they are of interest given the objectives of the longitudinal study.
  • Emphasis on this aspect of the project is on problem gamblers – those who moved into that category have moved out to that category or whop appear to have remained in that category. CATI methodology has serious limitations when trying to understand people’s journeys. In a longitudinal study, understanding the context of individual’s lives is important and the best method to uncovering those dynamics is via sensitively conducted interviews.
  • Refreshed -phone calls -email -newsletter No incentives used until wave three
  • 70% participation rate
  • 60% female 40 % male
  • This includes all people in wave two who gambled
  • Interesting to note the different preferences according to risk status
  • Graph shows preferences for gambling: Alone With one other In group Interesting to see that Most problem gamblers 77.8% prefer to gamble alone
  • Read these out then refer to graph on next slide
  • The Kessler 10 is a short measurement scale containing ten questions which estimates general psychological distress. Participants in both waves of the study were asked these questions. In Wave Two, only 40 per cent of problem gamblers score as likely to be well on the Kessler 10 compared to 92.4 per cent of non-problem gamblers.
  • Read this slide then refer to graph on next page
  • This graph shows self reported smoking in the past twelve months. Very high rate of smoking in problem gambling population
  • As part of the Wave Two study, participants were asked questions about life events.
  • This table shows the transition (i.e. the shift from risk status, or pgsi category from wave one to wave two) Yellow highlights- number who did not shift ( i.e 29 problem gamblers in wave one remained problem gamblers in wave two) NG- NPG- score of Zero Most stable groups were PG (72.5%) did not shift andNPG (87.8%) did not shift Biggest shift into PG was from MR
  • Incidence: cohort was weighted for demographics to get 12 month rate. So approximately half of our problem gamblers were not rated problem gamblers 12 months previously. A prevalence rate for wave two is not given as it is not a population-based sample any longer (therefore, not really representative of the Victorian adult population). NODS CliP2 – anyone who had ‘EVER’ gambled –epi—five questions then full NODS Different definitions of problem gambling; however, used to give a general idea. The results show that one third of new problem gamblers between wave one and two had never had a previous history of problem gambling while two thirds did.
  • Also associated is those who stated that they had troubles at their work and increasingly argued with someone close to them
  • Again we are getting on the surface conflicting results. For example, a new partner was associated with people moving into the problem gambling category. This study of movements between waves one and two indicate that the same factors can explain contrary movements. We need to: explore with qualitative work and to extend the study as long as possible to establish if these are anomalies or behaviour this way over time. Substance abuse like alcohol and smoking may have a substitution effect fore some who could develop problem gambling and /or for those who may move out of that state. That is, they may substitute gambling for more substance abuse.
  • Early outcomes from the (Study of Gambling in Victoria) longitudinal study, 2nd wave of results

    1. 1. Mr Paul Marden and Ms Rosa Billi Office of Gaming and Racing Research
    2. 2. Victorian Longitudinal Study -overview and early outcomes Rosa Billi and Paul Marden Responsible Gambling Awareness Week Melbourne (CD/11/170804) 23 May 2011
    3. 3. Presentation Overview <ul><li>Public Health Approach </li></ul><ul><li>Background </li></ul><ul><li>Methodology </li></ul><ul><li>Wave One </li></ul><ul><li>Wave Two results </li></ul><ul><li>Waves Three and Four </li></ul><ul><li>Qualitative component </li></ul>
    4. 4. What is a public health approach? <ul><li>Public Health approach </li></ul><ul><ul><li>prevention, intervention, treatment </li></ul></ul><ul><ul><li>goal to reduce ‘disease’, premature death, disease-produced discomfort and disability in the population </li></ul></ul><ul><li>Epidemiology </li></ul><ul><ul><li>is a branch of medical science that deals with the study of the causes, distribution, and control of disease in populations. Biostatistics is the application of statistics to a wide range of topics in biology. </li></ul></ul><ul><li>Cohort studies (i.e. longitudinal) prospective or retrospective </li></ul><ul><ul><li>describes any designated group of persons who are followed or traced over a period of time </li></ul></ul><ul><ul><li>from Latin cohors = warriors </li></ul></ul>
    5. 5. What is a public health approach? <ul><li>Prevalence </li></ul><ul><ul><li>the number of instances of a given disease or condition (i.e. problem gambling) in a given population at a designated time </li></ul></ul><ul><ul><li>usually expressed as a rate (0.7%) </li></ul></ul><ul><li>Incidence </li></ul><ul><ul><li>The number of instances of illness or a condition, commencing or developing, during a given period in a specified population </li></ul></ul><ul><ul><li>‘ new cases’ </li></ul></ul><ul><ul><li>usually expressed as a rate </li></ul></ul>
    6. 6. Background <ul><li>Major aims : </li></ul><ul><ul><li>Explore the causal pathways to, and from, problem gambling </li></ul></ul><ul><ul><li>Investigate the incidence of cessation or remission </li></ul></ul><ul><ul><li>Explore risks and vulnerabilities </li></ul></ul><ul><li>Key hypotheses guiding research: </li></ul><ul><ul><li>There are 13 hypotheses that are explored in this study. Some of the key ones are: </li></ul></ul><ul><ul><li>Gamblers move in and out of gambling risk categories. </li></ul></ul><ul><ul><li>Problem gambling is transitory in nature </li></ul></ul><ul><ul><li>Gamblers with moderate risk CPGI scores are considered at greater risk to graduate to problem gambling </li></ul></ul>
    7. 7. Background <ul><li>Key hypotheses guiding research: </li></ul><ul><ul><li>Gamblers with moderate risk CPGI scores are considered at greater risk to graduate to problem gambling </li></ul></ul><ul><ul><li>Co morbidities are clustered together and associated with problem gambling risk </li></ul></ul><ul><ul><li>Electronic Gaming Machines (EGMs) and other continuous forms of play are more likely to result in problem gambling development than non-continuous forms of play </li></ul></ul><ul><ul><li>There are many pathways to problem gambling </li></ul></ul><ul><ul><li>Most people who become problem gamblers are young and male </li></ul></ul>
    8. 8. Background <ul><li>Four waves </li></ul><ul><li>Wave Timing N </li></ul><ul><li>One July- Oct 2008 15000 </li></ul><ul><li>Two Sept 2009-Jan 2010 5003 </li></ul><ul><li>Three Oct 2010- Jan 2011 5620 </li></ul><ul><li>Qualitative March –Sept 2011 </li></ul><ul><li>Four Oct 2011-Jan 2012 </li></ul>
    9. 9. Methodology <ul><li>Wave One Epidemiology Baseline </li></ul><ul><li>Vic adult population 18+ </li></ul><ul><li>Sample of 15,000 </li></ul><ul><li>Computer Assisted Telephone Interviewing – CATI, landline, all waves </li></ul><ul><li>Gambler - anyone who had gambled once in the past 12 months (inc lotto) </li></ul><ul><li>Non-gamblers also included - health, recreation, demographics questions </li></ul><ul><li>A range of screens were used (a screen is not a diagnostic test, is usually administered by an investigator or agency and is not from a patient with a complaint) </li></ul><ul><ul><li>PGSI (problem gambling) </li></ul></ul><ul><ul><li>K10 (psychological distress) </li></ul></ul><ul><ul><li>CAGE (alcoholism and alcohol use disorder) </li></ul></ul>
    10. 10. Methodology <ul><li>PGSI </li></ul><ul><ul><li>a nine question scored index, the validated Problem Gambling Severity Index (from the Canadian Problem Gambling Index), which has been utilised by jurisdictions in Australia since 2001. </li></ul></ul><ul><li>Non problem: (score 0) will most probably not have experienced any adversity </li></ul><ul><li>Low risk gamblers: (score 1-2) are likely not to have experienced any adversity </li></ul><ul><li>Moderate risk gamblers: (score 3-7) may or may not have experienced adversity </li></ul><ul><li>- Problem gamblers (score 8–27) have experienced adversity </li></ul>
    11. 11. Methodology <ul><li>Wave One- the following were asked: </li></ul><ul><li>PGSI Kessler 10 </li></ul><ul><li>Self reported health Recreation </li></ul><ul><li>Gambling Readiness to Change Smoking </li></ul><ul><li>Gambling participation CAGE screen for alcohol abuse </li></ul><ul><li>Social capital Community connectedness </li></ul><ul><li>Life Events Help Seeking Behaviour </li></ul><ul><li>Substance use, suicide, crime Diet </li></ul><ul><li>Money management Gambling attitudes </li></ul><ul><li>NODS CLiP2 lifetime risk Demographics </li></ul>
    12. 12. Methodology <ul><li>Wave Two CATI </li></ul><ul><li>Core questions Additional contextual questions- </li></ul><ul><ul><li>Global financial crisis </li></ul></ul><ul><ul><li>Economic Stimulus Package </li></ul></ul><ul><ul><li>Victorian bushfires </li></ul></ul><ul><li>Wave Three CATI </li></ul><ul><li>Core questions </li></ul><ul><li>Additional contextual questions- </li></ul><ul><ul><li>Spring Racing carnival </li></ul></ul><ul><ul><li>Major sporting events </li></ul></ul><ul><ul><li>Linked jackpots </li></ul></ul><ul><ul><li>First big win </li></ul></ul>
    13. 13. Methodology-Qualitative <ul><li>Qualitative </li></ul><ul><li>In-depth, face to face interviews, one-on-one </li></ul><ul><li>Pool drawn from those who have consented to face to face or in depth interviews during W3 fieldwork </li></ul><ul><li>To explore risk and protective factors which contribute to the movement in and out of PG </li></ul>
    14. 14. Methodology <ul><li>Maintaining Contact </li></ul><ul><li>communications/media </li></ul><ul><li>www.gamblingstudy.com.au </li></ul><ul><li>refresher phone calls </li></ul><ul><li>refresher emails </li></ul><ul><li>newsletter </li></ul>
    15. 15. Findings-Wave Two Participation in W2 based on the PGSI status in W1 PGSI Risk segment Agreed to participation Wave 1 (n) Participated Wave 2 (n) Participation Rate % Non-gamblers 1493 1024 69% Non-problem 5029 3569 71% Low risk 423 274 65% Moderate risk 150 96 64% Problem gamblers 53 40 75% Totals 7148 5003 70%
    16. 16. Findings-Wave Two <ul><li>Gender of the Wave Two sample (n=5003) </li></ul>
    17. 17. Findings-Wave Two <ul><li>The four most popular gambling activities for all Wave Two participants were: </li></ul><ul><li>buying tickets in raffles, sweeps and other competitions, with nearly 64 per cent of the entire 5003 study population participating in this activity at least once in the last year </li></ul><ul><li>playing Lotto, Powerball and Pools (62.1 per cent) </li></ul><ul><li>playing electronic gaming machines (28.5 per cent) </li></ul><ul><li>racing (horse, harness and greyhound) (27.2 per cent). </li></ul>
    18. 18. Findings-Wave Two <ul><li>Amongst problem gamblers : </li></ul><ul><li>95.6 per cent played electronic gaming machines in the past year </li></ul><ul><li>nearly 78 per cent also played Lotto, Powerball and Pools. </li></ul><ul><li>In the moderate and low risk segments the most popular activity was: </li></ul><ul><li>playing Lotto, Powerball and Pools (84 per cent and 81.3 per cent respectively) </li></ul><ul><li>In the non-problem risk segment, the most popular activity was: </li></ul><ul><li>buying tickets in raffles, sweeps and other competitions (74.9 per cent) </li></ul>
    19. 19. Findings-Wave Two Gamblers within PGSI segments who gamble alone, with one other person or in groups
    20. 20. Findings-Wave Two <ul><li>Self-reported depression and anxiety </li></ul><ul><li>Over a half (51 per cent) of problem gamblers reported that they had depression whilst only 10.4 per cent of non-problem gamblers reported this condition. Similarly, nearly half (48.9 per cent) of problem gamblers reported anxiety disorders compared with 7.6 per cent of non-problem gamblers. </li></ul>
    21. 21. Findings-Wave Two K10 psychological distress scale
    22. 22. Findings-Wave Two <ul><li>Self-reported smoking </li></ul><ul><li>Participants in both waves were asked questions regarding their smoking behaviour, as part of the health and wellbeing survey. </li></ul><ul><li>Nearly 58 per cent of problem gamblers reported smoking in the past twelve months. In contrast, approximately 22 per cent of non-problem gamblers stated that they smoked in the past twelve months. </li></ul>
    23. 23. Findings-Wave Two Self reported smoking in past twelve months
    24. 24. Findings-Wave Two <ul><li>Life Events </li></ul><ul><li>Problem gamblers reported higher rates of several life events. </li></ul><ul><li>Nearly 43% of problem gamblers reported the death of someone close to them. The average for all gamblers was 29%. </li></ul><ul><li>Over one third of problem gamblers reported major changes to their financial situation compared to 20.2 % of non-problem gamblers </li></ul>
    25. 25. Findings-Wave Two <ul><li>Social Capital </li></ul><ul><li>Approximately 85 per cent of gamblers across all PGSI risk segments reported they could get help from friends and family if needed. </li></ul><ul><li>similar to the Victorian adult population. The Victorian Population Health Survey 2008 - over 80 per cent of Victorian adults could get help from friends and family if needed. </li></ul>
    26. 26. Findings-Wave Two <ul><li>Social capital </li></ul><ul><li>Less than 45 per cent of problem gamblers reported that they could get help, if needed, from friends, family or neighbours. </li></ul><ul><li>Less than 32 per cent of problem gamblers felt they were valued by society in comparison to nearly 70 per cent of all gamblers . </li></ul>
    27. 27. Findings Transitions W1-W2 Wave Two Completed 2009 NG NPG LR MR PG TOTAL Shifted W1 to W2 NG 1024 464 526 24 9 1 560 Wave One NPG 3569 240 3131 169 24 5 438 LR 274 9 144 81 38 2 193 MR 96 3 20 26 39 8 57 PG 40 0 2 0 9 29 11 Total 5003 716 3823 300 119 45 1259
    28. 28. Findings Transitions W1- W2 <ul><li>Stability and Change </li></ul><ul><li>5.6 % of gamblers increased their risk segment </li></ul><ul><li>(This means they moved into the low risk, moderate risk or problem gambling categories) </li></ul><ul><li>4.3 % of gamblers decreased their risk status. </li></ul><ul><li>(This means they moved away from problem gambling, moderate risk or low risk categories) </li></ul><ul><li>* NG ->NPG not included as risk (score = 0) </li></ul>
    29. 29. Findings Transitions W1-W2 <ul><li>Incidence (new cases) </li></ul><ul><li>12 month incidence rate - 0.36% </li></ul><ul><li>Vic prevalence rate at wave one - 0.7% </li></ul><ul><li>Lifetime Incidence- NODS CLiP2 </li></ul><ul><li>0.12% - (of 0.36%) new gamblers </li></ul><ul><li>0.24% - (of 0.36%) previous history of path/problem gambling (‘relapse’) </li></ul>
    30. 30. Trends and longitudinal studies <ul><li>You need more than one follow up (that is, wave two) to be definitive as to the factors which appear to be consistently associated with increasing or decreasing risk over time </li></ul><ul><li>Trends will appear when wave three and four data are analysed. </li></ul><ul><li>These trends will need to be identified using sophisticated statistical tools (not just logistic regression) </li></ul>
    31. 31. What were associated factors with wave two increasing risk? <ul><li>Those who have poor general and psychological health </li></ul><ul><li>Have smoked in the past year </li></ul><ul><li>Live in group households or one parent families </li></ul><ul><li>Speak a language other than English at home </li></ul><ul><li>Bet weekly on racing </li></ul>
    32. 32. BUT...we have to be careful jumping to conclusions… <ul><li>The measure for psychological distress ( Kessler 10) is associated with increasing AND decreasing risk levels between waves one and two. </li></ul><ul><li>It is possible that this is a very dynamic factor in people’s lives. </li></ul><ul><li>Will this be maintained in subsequent waves? </li></ul>
    33. 33. What about those who moved into problem gambling in wave two? <ul><li>Strongest predictors of this movement are: people who took up/played gaming machines and those who played keno. </li></ul><ul><li>Other factors shown to be important are: poor general and psych health; those from one-parent families; people who have had a major illness or injury in past year; new marriage or other relationship partner. </li></ul>
    34. 34. What of those who moved in moderate risk category? <ul><li>Interestingly the factors that were associated with people who moved into the moderate risk category from lower risk groups were all gambling-related activities: </li></ul><ul><ul><li>Wagering </li></ul></ul><ul><ul><li>Gaming machines </li></ul></ul><ul><ul><li>Sports and events betting </li></ul></ul>
    35. 35. If we group problem and moderate risk gamblers together …. <ul><li>Between wave one and wave two, those who moved into either category (controlling for age and gender) one variable was particularly strong .…divorce. </li></ul><ul><li>Other factors associated with this increased risk were playing gaming machines, wagering and playing keno, clinical alcohol abuse </li></ul>
    36. 36. Factor associated with decreasing risk… <ul><li>No factors were found to be statistically significant for those moving out of problem gambling category. This will be explored in further analysis. </li></ul><ul><li>Moving to lower risk categories from all groups (including MR and LR) is associated with death of someone close, a new partner, increasing arguments with someone close, health factors and substance abuse (smoking, alcohol)… </li></ul>
    37. 37. <ul><li>The End ... </li></ul><ul><li>If only… more findings from the trend analysis will help us…stay tuned. </li></ul><ul><li>Thanks for listening, </li></ul><ul><li>Rosa and Paul </li></ul>

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