June 12, 2014 - PGS All Provider Meeting PowerPoint

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Oregon Problem Gambling Services

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  • Problem gambling associated with other risky behaviors

    Problem gambling is defined as gambling behavior that compromises, disrupts, or damages personal, family, or vocational pursuits (Volberg et al., 2008).
  • An Oregon youth survey estimates that about 63% of adolescents have gambled at least one point in their lives. Out of the sample (n=1,555), 13% admitted to gambling on a monthly basis, while 3% admitted to gambling on a weekly basis (Volberg et al., 2008)

    Ages 12-17
  • Prior-year gambling in the 80’s percentagewise

    Rates consistent
  • Casinos play a role in adolescent gambling.

    Even though we may find it hard to believe that teens are able to gamble in casinos, likely due to a perceived sophistication of security systems and to age restrictions, some adolescents are able to get past these restrictions and gamble (Welte et al., 2009; Fabiansson, 2006).

    Fabiansson (2006), in an assessment of youth gambling participation in rural Australia, found that in one of Australia’s largest casinos, approximately 700 underage individuals are caught each month
  • Thinking that gambling is “cool” may cause youth to gamble or to gamble more frequently with peers (not necessarily in a casino).

    McMullan et al. (2012) found that youth (especially those 15-18 years) were favorably disposed to casino ads. This group expressed a desire to gamble and perceived from ads that gambling has cultural capital, since it allows one to socialize with friends, win money quickly, have fun by playing, and feel excitement. Similarly, McMullen and Miller (2010) found that young adults were susceptible to casino advertisements.
  • However, research is limited since no studies have addressed the effect of a nearby casino on gambling behaviors in youth

    It is possible that living near a casino is positively correlated with youth gambling occurrence and frequency. Proximity may make casinos more accessible to youth, if they desire to sneak-in and gamble. The findings of Sévigny et al. (2008) and Adams et al. (2007) demonstrate the importance of the ease in accessibility in predicting casino game participation.
  • It is possible that living near a casino is positively correlated with youth gambling occurrence and frequency. Proximity may make casinos more accessible to youth, if they desire to sneak-in and gamble. The findings of Sévigny et al. (2008) and Adams et al. (2007) demonstrate the importance of the ease in accessibility in predicting casino game participation.
  • Previously mentioned ads make gambling look enticing

    Communities that do not have a casino may be exposed to less casino advertisements, since it may be more difficult for the individuals of these communities to travel to and regularly play at casinos.

    , especially family dinners. Gambling profits from casinos are often used to subsidize food and beverages, leading to cheaper meals at casinos compared to outside restaurants.
    Rural areas not a lot of opportuninties
  • Exposure to casinos at an early age may cause adolescents to think that gambling is cool and acceptable, further leading youth to gamble

    Moore and Ohtsuka (1999) found that youth gambled more frequently when one’s family and friends approved of gambling. Larimer and Neighbors (2003) found that peer approval of gambling was a predictor of gambling among college students
  • Past tense
  • If there is an association between early-onset gambling and casino proximity, interventions which prevent problem gambling may target adolescents living close to a casino

    Adams et al. (2007), based on their findings, suggests that casinos provide money and other resources to local schools for prevention and treatment programs for students with gambling problems that might emerge due to exposure and accessibility effects
    Other interventions may include implementing regulations and better practices to ensure that advertisements from casinos are socially responsible by not targeting children and adolescents (McMullen et al., 2012).

    SHORTEN!
  • Those with at-risk gambling were defined as those at an increased likelihood for developing a serious gambling problem if they continue to gamble.

  • Inquiries were sent to other states that assessed gambling in youth about the possible use of their datasets. However, no responses from these states were received. Arizona was the only state to respond and allow the use of their youth data (optional)
  • May control for regional differences throughout state.

    Also, ideal since at most The most casinos that a city has are three (in Tucson). This is ideal since many casino communities only have one or a few. Many casino communities do not resemble Las Vegas or Atlantic City, where the main industry is gambling and attracts tourists from all over the United States (optionak)

  • Includes, public and charter schools

    Participants with valid responses



  • so students in different schools were likely to interpret the instructions in similar fashions. To further reduce response bias, the questionnaire was pretested, using a well-developed and tested administration protocol. This was to ensure that students would comprehend the meaning of every question. After completion, all surveys were mailed to Bach Harrison L.L.C. and electronically scanned. Bach Harrison L.L.C. provided technical assistance to the Arizona Criminal Justice Commission (Harrison, 2012).

    Collected between January and April 2012
  • Determination granted. Approval not needed since data were collected anonymously

    Sent by Director

    STATA 12 used for cleaning of data and analyses

    Can shorten!!
  • At least one casino

    Participants that have zip-codes that belong to a town or city that has a casino(s) were in the proximate group. All other participants were in the other group, those who presumably lived further away from a casino(s).
  • Responses were never, before but not in past year, at least once in past year, once or twice a month, once or twice a week, and almost daily

    Mark a frequency for 10 gambling activities
  • Lifetime gambling: responses for each activity combined
  • With the exception of rural versus urban status, information taken from AYS

    Did not need to adjust for no. of casinos. Majority of towns only have one casino. Exception Tucson
  • The characteristics of this study’s sample were determined by calculating frequency distributions for each of the variables.
  • Say how I used logistic and multinomial

    Diagnostics and outlier detection after models determined

    Adjusted for important covariates as well as interaction terms.

    Interactions including proximity and other covariates were assessed since proximity was our predictor of interest.

    I included sex interactions, because gender is a risk factor for engaging in risky behaviors in general. For example, young men who drink alcohol or use drugs may be more likely to gamble than young women who abuse substances, even though substance abuse may increase the likelihood of gambling for both groups.

    I included grade interactions since age (correlated with grade) may affect one’s ability to gamble; for example, younger adolescents may have less money to gamble with or lack the necessary transportation to gamble with peers.

    Multinomial logistic regression

    Never base level!
  • The mean age was 15.2 years (SD=1.7). Gender was evenly distributed, with 50.5% of the sample being female and 49.5% being male. Approximately 25.9 % of the sample lived in close proximity to at least one casino, and the prevalence of youth who have ever gambled was 72.1%.
  • Important Characteristics: Grade, Sex, Race, Rural vs. urban status, alcohol and drug use, Smoking status, Parental living situation, Whether one skipped school,

    Univariate analyses done for proximity and each covariate

    Using a criteria of α=.05, casino proximity alone did not appear to be a predictor of lifetime gambling (p=.21). The odds of an adolescent living near a casino having ever gambled were .97 times less than the odds of an adolescent living far from a casino having ever gambled
  • Proximity was only a significant predictor of lifetime gambling for eighth graders. Eighth graders who lived near a casino were approximately 10% more likely to report ever gambled (OR=1.1; 95% CI =1.02 – 1.2, p=.01).

    Tenth graders who lived near a casino were 4% more likely to report ever gambled (OR=1.04; 95% CI=.95 – 1.14, p=.36). Twelfth graders who lived near a casino were 5% less likely to report ever gambled (OR=.95; 95% CI=.86 - 1.04, p=.239).

    Although not statistically significant!
  • Due to complexity, just reported the final model

    After adjusting for Grade, Sex, Race, Rural vs. urban status, alcohol and drug use, Smoking status, Parental living situation, Whether one skipped school, casino proximity distinguished youth who gambled at least once in the past 12 months, monthly, weekly, and daily from youth who have never gambled. Did not predict whether one gambled before, but not in the past year

    For each gamble frequency, grade again an effect modifier

    RRR calculated!

    Casino proximity was a predictor of gambling at least once in the past year, with grade level serving as an effect modifier (p=.04). Eighth graders who lived near a casino were 14% more likely to have gambled at least once in the past year compared to eighth graders far from a casino.

    Tenth graders who lived near a casino were 22% more likely to have gambled at least once in the past year Proximity was only non-significant for twelfth graders. Twelfth graders who lived near a casino were 6% less likely to have gambled at least once in the past year.
  • Eighth graders who lived near a casino were 13% more likely to have gambled monthly (RRR=1.13, 95% CI=.98 - 1.31). Tenth graders who lived near a casino were 6% less likely to have gambled monthly (RRR=.94, 95% CI .77 – 1.13). Twelfth graders who lived near a casino were 17% less likely to have gambled monthly (RRR=.83, 95% CI=.67 - 1.03).

    Grade a significant effect modifier (p=.004)
    However, proximity unable to predict monthly gambling for all three grades
  • Casino proximity was a predictor of weekly gambling, with grade level serving as an effect modifier. The relationship between proximity and weekly gambling was only significant among twelfth graders.

    Eighth graders near a casino were 5% more likely to have gambled weekly compared to eighth graders living far from a casino .
    Tenth graders near a casino were 3% less likely to have gambled weekly.
    Twelfth graders near a casino were 45% less likely to have gambled weekly (RRR=.55, 95% CI=.36 - .82), suggesting the protective factor of age
     
  • Casino proximity was a predictor of daily gambling, with grade level serving as an effect modifier. The relationship between proximity and weekly gambling was only significant among twelfth graders and was of borderline significance.

    Eighth graders near a casino were 12% more likely to have gambled daily compared to eighth graders far from a casino.
    Tenth graders near a casino were 9% more likely to have gambled daily.
    Twelfth graders near a casino were 41% less likely to have gambled daily, suggesting the protective factor of age.

  • Thus, proximity a predictor of lifetime gambling and frequency but must be stratified according to grade!!

    Being in the 12th grade may play a protective factor among the higher gambling frequencies (weekly and daily)
  • Not to generalize outside AZ

    In this study, lifetime rates and gambling frequencies decreased with an increase in grade level. For example, In the 2012 AYS, 75% of 8th graders, 72% of 10th graders, and 67% of 12th graders reported ever gambling.

    This was unusual
  • These three variables are possible confounders and are not on the AYS. However, using the AYS was a cost-effective way to gather data, because there are no current existing datasets that account for youth gambling, casino proximity, and every possible confounder. It would be costly to issue surveys that measure all possible confounders, as well as the exposure and outcome. Thus, it would not be feasible to discard the AYS in favor of gathering new data.

    Possibility for misclassification since zip-codes do not always belong explicitly to one town and some towns are bigger than others. One may reside in a zip-code that is in multiple towns and be incorrectly classified as living near a casino. Participants may have a zip-code that is exclusively in a town that has a casino, yet still be far from a casino for any effects to take place, because some towns are larger than others.

    Perhaps better to use exact difference

    Only data regarding zip-codes are collected With zip-codes, it is impossible to determine the exact distance one lives from a casino. I could only determine whether one lives in the same zip-code that is in a town that has a casino. Similarly, Adams et al. (2007) based casino proximity on if the casino was visible in the immediate or local community, which is a subjective measure; no exact mileages were used. Based on Adams et al. (2007), using zip-codes to determine proximity may have been a practical proxy measure.
  • With the exclusion of more subjects living near a casino, the results could either be skewed away from or towards the null hypothesis that casino proximity does not affect youth gambling in Arizona.

    Uneven response rates
  • All 21 casinos in Arizona used to determine casino proximity have been open for at least ten years prior to 2012. However, some states have recently opened casinos, such as within the past five years. The effect of a nearby casino may depend on how long the casino has been in business, due to the adaptation hypothesis, which proposes that people gradually adapt to the risks and hazards associated with potential objects of addiction (Shaffer, 2005).
  • Types, such as poker, slots,

    Did not control for these types

    In 2012, legalized gambling in Arizona included 14,530 electronic gaming machines, a traditional state lottery, Indian casinos, pari-mutuel wagering, and charitable gaming
  • With many casinos, the sample sizes in the two casino proximity groups were large enough to detect any statistical differences
  • Those who gamble at a higher frequency may be more of a concern compared to those who have only tried gambling once or gamble once a year. Gambling frequency may be associated with gambling severity, although not always the case.

    A survey of Maryland adults found that those who gambled weekly had a higher percentage of problem and at-risk gambling compared to those who gambled monthly or only in the past year (Shinogle, Norris, Park, Volberg, Haynes, & Stokan, 2011)

    Thus, it is of some comfort that casino proximity did not positively correlate with gambling on a weekly or daily basis. Youth who gamble on a weekly or daily basis may be more at risk for developing gambling problems compared to youth who gamble less frequently.

    Although associations found were minor
  • Additionally, one may only need that initial gambling experience

    Validated studies before interventions

    Adams et al. (2007) suggests that casinos provide money and other resources to local schools for prevention and treatment programs for gambling problems that may materialize due to exposure or accessibility effects.

    Casinos may be responsible by using ads that show gambling as a pleasurable experience, meanwhile showing that it is possible to have fun, win money, have social status, and experience excitement without gambling (McMullan et al., 2012). Such ads may promote gambling among adults while minimizing harm that may result from naïve views of the value and purpose of gambling.
  • This current study was only able to examine gambling frequency, which is not always an indicator of problem gambling. Practical to examine frequency since on AYS. However, problem gambling should be directly assessed due to its negative consequences

    It may be useful to examine youth casino proximity, because the environment that one grows up in may play a key role in the development of one’s attitudes and habits towards gambling. Growing up with the belief that gambling is acceptable and exciting may be motivation for adults to start or keep gambling. Alternatively, growing up in a community that hosts a casino may serve as a protective factor for adult onset problem gambling by producing an inoculation effect.

    Thus, discovering the long-term impacts of growing up in a casino community hold important public health implications and deserve further study.
  • June 12, 2014 - PGS All Provider Meeting PowerPoint

    1. 1. ADDICTIONS AND MENTAL HEALTH Problem Gambling Services WELCOME Problem Gambling All Providers Meeting Hosted by Problem Gambling Service Staff June 12, 2014 GotoMeeting Webinar We will begin in a few moments…….
    2. 2. 2 Webinar Etiquette and Structure • Please mute your phone when not speaking to reduce background noise. – *6 to mute – *6 to unmute • To minimize the GoToMeeting box from your screen, click on the orange arrow button. Click again to bring it back. • Please hold your questions for all presenters until the end of their presentations of the webinar. • You can use the chat box to ask questions at anytime during the webinar, and we will read and answer at the end of each presentation.
    3. 3. Agenda Items • State Updates (10 minutes) • Client Finding Outreach Strategic Plan (10 minutes) • Presentation from Oregon Lottery on Helpline new look and feel (20 minutes) • Presentation from Problem Gambling Student Research Grant: Does the Presence of a Casino Impact Community Youth Gambling Behaviors? (20 minutes) • Presentation on data: Who’s using special programs? (15 minutes) • Use of Aftercare and billing codes (5 minutes) • Questions and Answers (10 minutes) 3
    4. 4. State Updates • Staff Updates- • Treatment Site Reviews • Prevention Meet and Greets • Regional Trainings • Fall Oregon PGS Conference- Newport, OR 4
    5. 5. State Updates Staff Update  Roxann Jones, new PGS Prevention Coordinator  The AMH PGS Unit is now fully staffed! 5
    6. 6. State Updates Treatment Site Reviews: Simon Williams, PGS Treatment Compliance Specialist  Make sure final assessments are completed timely, and in the chart, and the service plan addresses the final treatment timeline component in the plan.  Even though OARs remove the discharge summary from the treatment chart, the chart needs to have this information included in the documentation. 6
    7. 7. State Updates Prevention Meet and Greets, Roxann Jones, PGS Prevention Coordinator  Hopes to meet with most of the prevention coordinators at the regional trainings coming up this summer; otherwise, will make a point to meet via phone calls, and in person as well. 7
    8. 8. Regional Trainings • 6 trainings this summer (Albany, Tillamook, Baker City, Bend, Grants Pass and Portland area) • 6 hours (lunch provided) 9:00 am to 3:00 pm • Purpose: – Strengthen local outreach plans/efforts – Strengthen the relationship and collaboration between local treatment services providers, local prevention specialist and agency executives, along with state staff – Help to develop regional collegiality among treatment providers and prevention specialists. – Spark excitement, motivation and networking • Encouraging PGS prevention and treatment providers, along with their program managers to make these trainings a priority regarding attendance. • If you need a registration and/or subsidy form, email Patricia at patricia.alderson@state.or.us 8
    9. 9. Fall OR PGS Conference • Slated for October 9 &10, 2014 • Hallmark Resort, Newport, Oregon • Keith Whyte, National Council, will be the featured speaker, as well as Jeff Marotta, talking about problem gambling, online gambling, as well as the past, present, and the future regarding this subject. • Save the Date came out in an email to everyone; please mark your calendars • A registration form and information will be coming out a couple months prior to the conference. 9
    10. 10. PGS Strategic Plan for Client Finding Outreach • 2014-16 – Client Finding Outreach Webinars-Completed – Regional Trainings-In Process – Development of statewide method for collecting and measuring outcomes – New and updated outreach materials (brochures, canned presentations, etc.) – Hire consultant to provide PGS outreach technical assistance and development of outreach plan. – Add language to prevention contract stipulating a percentage of funds must be designated to outreach efforts. – Development of PGS 5- year Strategic Plan to improve and support program structure 10
    11. 11. Helpline Web Page Redesign • Presented by Shad Barnes Online Marketing Manager Oregon Lottery shad.barnes@state.or.us 503-540-1082 11
    12. 12. “Replacing destructive thoughts with hope filled optimistic ones bring peaceful and confidence producing circumstances.” 12
    13. 13. 13 WHY CHANGE? • All efforts should lead back to the goal of engaging with more at risk individuals and families affected by problem gambling. • Reach the at risk audience in a more effective, more relevant manner. • Create a consistent look and feel that is pleasing to the eye, easy to read and commensurate with current media trends. • Improve the capture and collection system to best capitalize on advertising and marketing campaigns. • Above all, this process is about helping more people in need.
    14. 14. 14 CURRENT TRADITIONAL • Brochures • Posters • Terminal Stickers
    15. 15. 15 CURRENT SITE
    16. 16. 16 WHAT ARE USERS DOING?
    17. 17. 17 RECAP • Current designs are dated. • Images convey sadness. • Dark color schemes. • Long copy. • No hierarchy, what should the reader do. • Where is the call to action? Where is the hope in recovery? • Is this a web address or a phone number?
    18. 18. 18 THE MESSAGE – WHAT TO SAY? • Everything should convey a feeling of hope. • Messages should lead to phone calls. • Open, friendly, trustworthy, sensitive, non- judgmental. • Emphasize that treatment is FREE and EFFECTIVE. • Should use imagery and mention of Oregon and Oregonians whenever possible.
    19. 19. 19 BRANDING RECOMMENDATION In thinking about the “name” we want this to be bigger than a phone service. While the telephone is still the best way to connect, calling it a helpline feels too small in scale. OREGON PROBLEM GAMBLING NETWORK www.oregonproblemgamblingnetwork.org www.oregonpgn.org We will likely purchase additional domains.
    20. 20. 20 BRANDING RECOMMENDATION IMAGERY The images should convey a sense of hope, helpfulness, happiness and inclusion. People should be from all walks of life, genders, ages, ethnicities, races and should never display a look of despair or pain. Basically everyday people who make the viewer feel like they made a life decision to be healthy and are better for it. When possible, scenes should be Oregon-based. COLOR SCHEME Colors should be neutral to put emphasis on the images. Light, Inviting Combinations FONTS
    21. 21. 21 BRANDING RECOMMENDATION
    22. 22. WEB DESIGN RECOMMENDATION NOT THE ACTUAL LOOK – JUST A GUIDELINE
    23. 23. 23 WEB DESIGN RECOMMENDATION NOT THE ACTUAL LOOK – JUST A GUIDELINE
    24. 24. 24 WEB DESIGN INTERIOR HIGHLIGHTS • Informational • Video • Minimal Copy • Image Heavy • Interactive • Search Engine Optimized content • Content Management System – Update your own informationNOT THE ACTUAL LOOK – JUST A GUIDELINE
    25. 25. 25 OREGON PARTNERSHIP FOR PROBLEM GAMBLERS All attribution goes to the Oregon Partnership for Problem Gamblers. It will include all the organizations that cooperate to provide this valuable service to Oregonians. Never any direct attribution to the Oregon Lottery, or any other specific organization.
    26. 26. 26 We are nearly final with logo development and color palettes. We also have received a statement of work from our digital agency that is going to help with some of the design work, and recently hired a creative agency to help create our next TV commercial. We plan to present first drafts in July and hopefully be final with re-branding by late August if not sooner. NEXT STEPS
    27. 27. Youth Gambling and its Association with Casino Proximity Ashley Reynolds 27
    28. 28. Casino Proximity and its Association with Youth gambling This study sought to determine if casino proximity is associated with youth gambling and its frequency. The 2012 Arizona Youth Survey was used (n = 66,127), analyzed using ordinary logistic regression and ordered logistic regression models. This study may aid prevention efforts in problem gambling since early-onset gambling was found to be a significant risk factor of at-risk gambling in adolescents (Winters, Stinchfield, Botzet, & Anderson, 2002), and adults with severe gambling problems are likely to have begun gambling at an earlier age (Volberg, Gupta, Griffiths, Olason, & Delfabbro, 2010). In order to prevent problem gambling, in either youth or adults, consideration is important to identify factors that contribute to early- onset gambling and its frequency. 28
    29. 29. Background • Adolescent gambling a problem in the United States. • Gambling frequency associated with alcohol, tobacco, and marijuana use (Volberg, Hedberg, & Moore, 2008). • Problem gambling in youth associated with drug and alcohol use, poor seatbelt use, violence, and risky sexual activity (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010) 29
    30. 30. Background • The estimated prevalence of youth gambling indicates that it should be addressed 30
    31. 31. Volberg et al. (2008) • Oregon youth survey (n=1,555) • 63% of adolescents have gambled at least one point in their lives • 13% gambled on monthly basis • 3% gambled on weekly basis 31
    32. 32. Welte, Barnes, Tidwell, & Hoffman (2009) • National survey of youth (n=2,274) • 68% gambled within past year • 11% more than twice per week 32
    33. 33. Winters, Stinchfield, Botzet, & Anderson (2002) • Prospective cohort study of 305 adolescents over 8 years in MN • Rates of prior-year gambling found to be consistently high for each year • Rates of regular gambling around 20% • Rates of problem gambling ranged from 2.3 to 4.3% 33
    34. 34. Role of Casinos in Adolescent Gambling • Some adolescents able to get past age restrictions and gamble (Welte et al., 2009; Fabiansson, 2006). • Fabiansson (2006) found that in one of Australia’s largest casinos approximately 700 underage individuals are caught each month 34
    35. 35. Casino Advertisements • Casinos may influence youth gambling by making gambling appear “cool” • Casino advertisements effect youth (McMullen & Miller, 2010; McMullan, Miller, & Perrier, 2012). • From ads, gambling has cultural capital 35
    36. 36. Casino Proximity and Gambling • Adult studies found positive link between proximity and gambling • A correlation between casino proximity and participation in casino games/casino expenditure (Sévigny et al., 2008) • Participating in casino slots and table games more frequent in students attending university near a casino (Adams et al., 2007) 36
    37. 37. Casino Proximity and Youth Gambling • No studies have addressed the effect of a nearby casino on youth gambling behaviors • Living near a casino may be positively correlated with lifetime gambling and frequency • Proximity may make casinos more accessible to youth, if they desire to sneak-in. - Findings of adult proximity studies demonstrate the importance of less travel time 37
    38. 38. Casino Proximity and Youth Gambling • Youth near a casino may be more exposed to casino advertisements. • Youth near a casino may be exposed to a social environment that approves of gambling. • Fabiansson (2006) found that in rural areas with casinos, parents are encouraged to bring their families to casinos for activities • Youth may see family visit casinos 38
    39. 39. Casino Proximity and Youth Gambling • Exposure to casinos at an early age may cause adolescents to think that gambling is cool • May lead youth to gamble - Friend and family approval a predictor of gambling among youth (Moore and Ohtsuka, 1999; Larimer and Neighbors, 2003) 39
    40. 40. Purpose of Study • To determine the prevalence of gambling and gambling by frequency • If casino proximity is associated with lifetime gambling • If casino proximity is associated with gambling frequency • All types of gambling examined 40
    41. 41. Significance of Study • If association between early-onset gambling and casino proximity, interventions preventing problem gambling may target adolescents near casinos • Casinos may: - Provide resources to local schools for prevention and treatment programs - Advertise responsibly 41
    42. 42. Significance • To prevent problem gambling in adolescents and adults, we should consider early-onset gambling and its frequency. • Adults with severe gambling problems are likely to have begun gambling at an earlier age (Volberg et al., 2010). • Early-onset gambling a significant risk factor of at-risk and problem gambling in adolescents (Winters et al., 2002) 42
    43. 43. 2012 Arizona Youth Survey • Measures prevalence and frequency of substance abuse among 8th, 10th, and 12th graders • Assesses risk and protective factors. • One of the few statewide youth behavioral surveys examining gambling and whose state has casinos 43
    44. 44. AYS • Conducted every 2 years by the Arizona Criminal Justice Commission • Conducted for 21 years • Ideal since many casinos in Arizona open before 2012 • Casinos scattered throughout state - 21 casinos located in 17 towns 44
    45. 45. Participant Recruitment and Informed Consent • Consent needed from schools, parents, and students • All 15 counties participated • 349 schools participated - Public and charter schools • 62,817 8th, 10th, and 12th grade participants 45
    46. 46. Data Collection • Collected anonymously • Collected between January and April 2012 • Teachers read scrip to students to ensure anonymity and reduce response bias • Questionnaire was pretested • After completion, mailed to Bach Harrison L.L.C. - Bach Harrison provided technical assistance 46
    47. 47. Data Use Agreement and Management • IRB approval not needed • Agreement granted by Arizona Criminal Justice Commission • SPSS file sent in February, 2014 • SPSS file converted to STATA 12 • Recoded variables 47
    48. 48. Predictor Variable- Casino Proximity • Measured by whether the participant lived in a zip- code that is in a town that has a casino(s) • Dichotomous variable • Casino must have been open before January 2012 48
    49. 49. Outcome Variables • Lifetime gambling and gambling frequency • Determined using same question on AYS 49
    50. 50. Outcome Variables • How often have you done the following for money, possessions, or anything of value: a. Played a slot machine, poker machine or other gambling machine? b. Played the lottery or scratch off tickets? c. Bet on sports? d. Played cards e. Bought a raffle ticket? f. Played bingo? g. Gambled on the internet? h. Played a dice game? i. Bet on a game of personal skill such as pool or a video game? j. Bet on a horse or other 50
    51. 51. Outcome • Responses are: - Almost every day - Once or twice a week - Once or twice a month - At least once in the past 12 months - Before, but not in the past 12 months - Never 51
    52. 52. Lifetime Gambling and Frequency • Lifetime gambling defined by whether an adolescent ever gambled, regardless of activity • Frequency defined by how often an adolescent gambled, regardless of activity. • For each participant, frequency was the highest frequency marked 52
    53. 53. Variables adjusted for • Grade • Sex • Race • Rural vs. urban status • Alcohol and drug use • Smoking status • Parental living situation • Whether one skipped school 53
    54. 54. Descriptive Statistics • Characteristics determined by calculating frequency distributions for each variable • Prevalence calculated for lifetime gambling • Prevalence calculated for each gambling frequency • 54
    55. 55. Inferential Statistics • Logistic regression used to determine if proximity is associated with lifetime gambling • Multinomial logistic regression used to determine if proximity is associated with gambling frequency – Base level: ‘never gambled’ • Determined both adjusted and unadjusted associations • Model diagnostics and outlier detection • Assessed for proximity, gender, and grade interactions • Criteria of α=.05 55
    56. 56. Descriptive Analyses • Mean age was 15.2 years (SD=1.7) • 50.5% female, 49.5% male • 46% in 8th grade, 30% in 10th grade, and 24% in 12th grade • Approx. 25.9% lived near at least one casino 56
    57. 57. Gambling Prevalence N Percentage Lifetime Gambling (n=60,891) No Yes 17020 43871 27.95% 72.05% Gambling frequency (n=60,891; Never Before, but not in the past 12 months At least once in the past 12 months Once or twice a month Once or twice a week Almost every day 17020 9048 17141 10015 4180 3487 27.95% 14.86% 28.15% 16.45% 6.86% 5.73% 57
    58. 58. Logistic Regression • Univariate analyses first conducted • Casino proximity not a predictor of lifetime gambling (p=.21; OR=.97) • After adjusting for important covariates, grade level an effect modifier between proximity and lifetime gambling (p=.009) 58
    59. 59. Logistic Regression • Relationship only significant among eighth graders 59 Main effect model Final model with interactions Variable OR (95% CI) P-value OR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate Referent 1.11 (1.02,1.20) Referent 1.04 (.85, 1.14) Referent .95 (.86, 1.04) .009
    60. 60. Multinomial Logistic Regression 60 Never- at least once in the past 12 months Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate Referent 1.14 (1.01, 1.29) Referent 1.22 (1.06, 1.40) Referent .94 (.81, 1.08) .04
    61. 61. Predicting Monthly Gambling 61 Never-once or twice a month Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate Referent 1.13 (.98, 1.31) Referent .94 (.77, 1.13) Referent .83 (.67, 1.03) .004
    62. 62. Predicting Weekly Gambling 62 Never- once or twice a week Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate Referent 1.05 (.85, 1.31) Referent .97 (.71, 1.34) Referent .55 (.36, .82) .008
    63. 63. Predicting Daily Gambling Never-almost every day Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate Referent 1.12 (.87, 1.44) Referent 1.09 (.76, 1.57) Referent .59 (.35, 1.00) .027 63
    64. 64. Summary • 8th graders near a casino 10% more likely to report ever gambling compared to those far from a casino • 8th graders near a casino were 14% more likely to have gambled in the past year. • 10th graders near a casino were 22% more likely to have gambled in the past year. • 12th graders near a casino were 45% less likely to gamble weekly and 41% less likely to gamble daily. 64
    65. 65. Discussion • Must be careful not to generalize grade*proximity interactions • Past findings that lifetime gambling and frequency may positively correlate with grade level (Volberg et al., 2008; Carlson & Moore, 1998; Shapira et al., 2002; Wallisch; 1993). • Contrary to our findings and rationale – Grade negatively correlated with lifetime gambling – Grade negatively correlated with gambling frequency 65
    66. 66. Limitations of Study • Unable to control for depression, a family history of gambling, and if one has recently moved • Measurement of casino proximity: if an adolescent resides in a zip- code that belongs to a casino town • Defining proximity as within a specific distance may be more reliable • However, such data not collected by the AYS • Adams et al. (2007) based proximity on if the casino was visible in the immediate or local community, also a subjective measure 66
    67. 67. Limitations • May not be representative of Arizona - Pima County comprised of 14% students statewide and only 8% of the sample (Harrison, 2012) - Exclusion of youth living near a casino: Pima county includes Tucson (home to three casinos) - Uneven grade distribution: 46% in 8th grade, 30% in 10th grade, and 24% in 12th grade - Possible exclusion of older youth who gamble 67
    68. 68. Limitations • Results may not be generalizable • Only AZ youth surveyed • Other regions gambling is more or less mature • All 21 AZ casinos open at least 10 years • Need to consider adaptation hypothesis (Shaffer, 2005) 68
    69. 69. Generalizability • All AZ casino towns range from having 1-3 casinos - Need to consider casino heavy communities such as Las Vegas and Atlantic City • States differ in types of gambling available • Types may influence youth gambling rates • Studies need to be repeated in other regions 69
    70. 70. Strengths • Study is first of its kind • Large dataset (n = 62,603) • Easy to detect any statistical differences • Large enough group near a casino 70
    71. 71. Implications • Findings may be of comfort because proximity not positively associated with higher frequencies • Frequency associated with severity (Shinogle, Norris, Park, Volberg, Haynes, & Stokan, 2011) • Should be concerned that proximity was positively associated with prior-year gambling (among 8th and 10th graders) and lifetime gambling (among 8th graders) 71
    72. 72. Implications • Some individuals in the population gamble less frequently and yet gamble more heavily (Abbott, 2001; Abbott, Volberg, & Rönnberg, 2004). • One may only need initial experience • Interventions be implemented • Casinos provide resources for prevention and treatment for local communities • Socially responsible advertising 72
    73. 73. Future Studies • Address relationship between casino proximity and problem gambling in youth • Address relationship between youth casino proximity and gambling problems later in life • Current studies have only examined adult casino proximity and problem gambling. 73
    74. 74. Who’s using special programs? Presented by Tom Moore, Phd Herbert and Louis, LLC 74
    75. 75. Minimal Intervention Program (SAFE; GEAR) • Purpose: fill the gap in available treatment for individuals who did not meet full diagnostic criteria for pathological gamblers and to provide services to pathological gamblers who could not attend brick and mortar programs. Home-based with workbook and phone consultation.  9/2001 – 6/2007 (Cascadia: n = 185)  7/2007 - present (Emergence: n = 340)  Older (p < .01) than TAU: 53.5 years compared to 46.9 years  More likely (p < .01) to have 1st gambled older: 31.1 years compared to 24.4 years  Slightly more likely to be female  Slightly more likely to have higher DSM Score: 8.2 to 7.7  For enrollment call the Helpline! 75
    76. 76. Respite Care  Purpose: Short term stabilization with referral from TAU with intent for follow-up/continuing care at the referring agency. (Some gaps in funding years)  9/2001 – 5/2009 (Columbia County: n = 83)  9/2001 – current (Josephine/Options for Southern Oregon: n = 104)  More likely female; divorced  (Small sample last five years)  For admission contact PGS & Options 76
    77. 77. Residential Care  Purpose: Provide acute stabilization and intense residential care for high risk patients. Must be referred by a TAU outpatient program with the intention for follow-up continuing care at the referring agency following residential treatment  7/06 – 6/09 (Cascadia: n = 237)  7/09 – Present (Bridgeway: n = 291)  No difference in age or gender with TAU  Significantly more (p < .01) DSM Criteria Endorsed: 9.2 vs. 7.7  Significantly more likely (p< .01) for younger first gambling experience: 18.3 years vs. 24.4 years  More likely to be single-never married, homeless, higher gambling debt, increased suicidality than TAU  ALOS: 34.3 days  For admission/logistics contact Bridgeway Recovery 77
    78. 78. Aftercare and Billing Codes • Aftercare: Automatic one year after case closing with H&L. – G2100 for group; H2027 for individual • Consolidated document can be found on PGS web page at: http://www.oregon.gov/oha/amh/gambling/BILLING%20CODES%20 012214.pdf. • Flex Code – ‘FLEX’ Submit in normal format – Comes from agency’s AD81 funds – Keep detailed records on site for possible audit 78
    79. 79. PG Flex Funds • PG flex funds must be used for Problem Gambling Services. • Funds can be used for PG wraparound type services, such as travel expenses for assisting client to residential treatment, etc. • Fund can also be used for supporting PG staff’s workforce development needs (i.e., trainings, etc.). • If you are a subcontractor for a county, you may need to contact the county for use of funds approval, outside the scope of treatment, outreach and prevention. 79
    80. 80. Questions 80
    81. 81. Contacts • Greta Coe, Problem Gambling Services Manager – Greta.l.coe@state.or.us; 503-945-6187 • Simon Williams, Problem Gambling Treatment Specialist – Simon.o.williams@state.or.us; 503-945-6555 • Roxann Jones, Problem Gambling Prevention Specialist Roxann.r.jones@state.or.us; 503-947-5548 • Patricia Alderson, Problem Gambling Administrative Support – Patricia.alderson@state.or.us; 503-945-9710 81
    82. 82. Final Notes: • Power point, minutes and CEU certificates will be emailed to you next week. Thanks for your participation in this webinar, and for the work that you do every day! 82
    83. 83. 83

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