Gender Differences in Characteristics of Chinese Treatment-Seeking Problem Gamblers

J Gambl Stud (2007) 23:145–156 DOI 10.1007/s10899-006-9054-0

ORIGINAL PAPER

Catherine So-kum Tang Æ Anise M. S. Wu Æ Joe Y. C. Tang

Received: 5 October 2006 / Accepted: 22 December 2006 / Published online: 24 January 2007 Ó Springer Science+Business Media, LLC 2007

Abstract A total of 952 (841 men and 111 women) Chinese treatment-seeking problem gamblers completed self-report assessment forms. Female in contrast to male gamblers were more likely to be older, married, less educated, and without employment. Female gamblers also started gambling at an older age, had a shorter gambling history, preferred casino and mahjong gambling, and reported more somatic complaints and suicidal thoughts. Male and female gamblers accumulated similar amount of gambling debt and reported an average of 12 gambling-related problems on the Chinese version of the South Oaks Gambling Screen [Lesieur and Blume (Am J Psychiatry 144:1184–1188, 1987)]. Both groups were similarly troubled by their indebtedness, inability to control gambling, and gambling-related interpersonal problems. However, female gamblers had fewer means to pay their gambling debt. Given that signiﬁcant gender-related differences were observed in Chinese problem gamblers, prevention and treatment services should attend to speciﬁc needs of male and female gamblers.

Keywords Gender and problem gambling Æ Chinese problem gamblers Æ Chinese gambling behaviors Æ Asian treatment-seeking gamblers Æ Chinese female gamblers

C. S. Tang (&) Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong e-mail: [email protected]

A. M. S. Wu Department of Psychology, The University of Macau, Taipa, Macau, China

J. Y. C. Tang The Caritas Addicted Gamblers Counseling Center, Tuen Mun, NT, Hong Kong 123 146 J Gambl Stud (2007) 23:145–156

Introduction

In past centuries, gambling has been a predominantly male pastime and related research has typically focused on vulnerability factors, negative consequences, and treatment of men (Lesieur & Blume, 1991; Mark & Lesieur, 1992). With the expansion of legalized gambling in recent years, women nowadays have more opportunities to engage in various gambling activities. This is also accompanied by an increasing attention to problem gambling in women. However, current research about female gamblers is mainly conducted in English-speaking nations, very little is known about gambling behaviors of Asian women (Petry, Armentano, Kuoch, Norith, & Smith, 2003; Raylu & Oei, 2004; Shaffer, Hall, & Vander Bilt, 1997). For the present study, we aim to fill this knowledge gap by investigating psychosocial characteristics of Chinese female treatment-seeking gamblers and to compare them with their male counterparts. In Western populations, gender differences are found in demographic characteristics, pattern of gambling activities, and types of gambling-related problems among treatment-seeking problem gamblers. Compared to male gamblers, female gamblers are older at the time of entering treatment, have a later onset and shorter duration of gambling (Grant & Kim, 2002; Ibanez, Blanco, Moreryra, & Saiz-Ruiz, 2003; Nelson, LaPlante, LaBrie, & Shaffer, 2006; Potenza et al., 2001), are more likely to be without regular employment (Ladd & Petry, 2002; Tavares, Zilberman, Beites, & Gentil, 2001), have stronger preference to gamble on slot machines and bingo than on cards, sports, and horse races (Crisp et al., 2004; Grant & Kim, 2002; LaPlante, Nelson, LaBrie, & Shaffer, 2006; Petry, 2003), and are more motivated to gamble for social reasons than for financial gains (Brown & Coventry, 1997; Lesieur & Blume, 1991; Trevorrow & Moore, 1998). Male and female gamblers usually report similar number of gambling-related problems (Ladd & Petry, 2002). How- ever, female gamblers tend to have more financial problems and credit card debts, whereas male gamblers are more likely to be indebted to bookies and to report illegal activities and drug/alcohol use (Ladd & Petry, 2002; Potenza et al., 2001). Female as compared to male gamblers are also more likely to have received mental health treatment and to report suicide attempts subsequent to gambling (Potenza et al., 2001). Some of the above gender-related differences are also found in community recreational gamblers (Potenza, Maciejewski, & Mazure, 2006) and problem gamblers participating in voluntary casino self-exclusion programs (Nower & Blas- zcsynski, 2006). In Chinese societies, gambling has been a national pastime and a way of life. Excessive gambling may meet with social disapproval (Luk & Bond, 1992), but is generally not considered a psychiatric illness (Chinese Medical Associations & Nanjing Medical University, 1995). Thus, there is a lack of prevention and treatment services for problem gambling in most Chinese societies. With rapid social and economic changes in recent years, Chinese have also engaged in Western and new forms of gambling, such as betting on sports and internet games, in addition to traditional gambling activities of casino and mahjong gambling (Fong & Ozorio, 2005; Ozorio & Fong, 2004; Sun & Li, 2006). Recent large-scale community surveys in Chinese societies have shown that by using the gambling behavior index of the Diagnostic and Statistics Manual of Mental Disorders (American Psychiatric Association, 1994), the estimated lifetime prevalence of problem gambling is about 123 J Gambl Stud (2007) 23:145–156 147

3%–5% in Hong Kong (Hong Kong Home Affairs Bureau, 2005; Wong & So, 2003), Macau (Fong & Ozorio, 2005), and Taiwan (Yeh, Hwu, & Lin, 1995). Chinese men as compared to women and individuals with lower as compared to higher educational attainment are more likely to engage in problem gambling (Fong & Ozorio, 2005; Sun & Li, 2006). Unlike earlier years when gambling was viewed as a social and recreational activity, Chinese gamblers nowadays tend to take high risks while gambling to seek instant rewards either for quick profits or for satisfying strong immediate sensations and excitement (Lau & Ranyard, 2005; Ozorio & Fong, 2004). Consequently, Chinese gamblers typically report severe financial, family, and work difficulties as a result of their gambling (Hong Kong Home Affairs Bureau, 2005; Wong & So, 2003). Similar to earlier research in Western nations, female gamblers in Chinese societies are invisible due to researchers’ failure to undertake gender analysis. The present study represented the first attempt to identify gender-related differences among Chinese treatment-seeking problem gamblers. Based on prevailing literature on this topic, we speculated that there would also be gender differences among Chinese gamblers. We hypothesized that compared to Chinese male gamblers, Chinese female treatment-seeking gamblers would be older, have a shorter gambling history, report greater health/mental health problems, and engage in different gambling activities. We also speculated that Chinese male and female gamblers would encounter similar gambling-related problems.

Method

Recruitment of Participants

We collected data from one of the two new publicly funded treatment centers for problem gamblers in Hong Kong, a region where individuals have easy access to multiple forms of gambling such as legalized horse racing and casino gambling. The two treatment centers were established in 2003, shortly after the legalization of soccer game betting. These centers are mandated to provide free, non-residential, and voluntary treatment services to problem gamblers and their family members. The data collection period for this study was from October 2003 to September 2005. Chinese clients seeking services from the treatment center for the ﬁrst time were routinely requested to complete an assessment form during the intake session. The assessment form took about 30 minutes to complete, and included clients’ demographic characteristics as well as gambling-related information and problems. Clients were explained that the assessment form was for tabulation of center statistics, and information collected would also be analyzed by researchers to determine characteristics of Chinese gamblers. Clients were reassured that no individual identiﬁable information would be released to researchers. Oral consent was obtained from clients prior to completing the assessment form. During the study period, a total of 952 Chinese clients (841 men and 111 women) sought services from the gambling treatment center and were invited to complete the assessment form. No client refused to complete the assessment form.

123 148 J Gambl Stud (2007) 23:145–156

Assessment Form

Demographic Data

Clients were asked to provide information about their current age, gender, education attainment, marital status, and employment status.

Gambling History and Activities

Clients were asked about the age when they ﬁrst started gambling, number of years they had engaged in gambling, and amount of gambling debt. Clients were also asked whether they had engaged in the indicated gambling activities in the past, which included betting on horse races, soccer games, and mahjong games; lottery; and gambling on casino games such as blackjack, poker, roulette, and slot machines.

Somatic and Psychological Symptoms

Based on focus group meetings with problem gamblers prior to data collection, a checklist of commonly experienced symptoms was constructed. These symptoms include physical discomfort, psychological distress as in feeling unhappy, insomnia, losing interest in work, and suicidal ideations. Clients were asked to indicate the frequency or presence of these symptoms during the past three months, with ‘‘yes’’ and ‘‘no’’ responses.

Gambling Behaviors and Problems

The 20-item self-report South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987) was used to evaluate clients’ lifetime gambling-related behaviors and problems. The SOGS is a widely used screening instrument for problem gambling and shows good reliability and validity in community and clinical samples (Petry, 2005). The average lifetime score of treatment-seeking gamblers in the United States is about 12 (Petry, 2005). A total score of 5 or higher is typically used to classify probable pathological gambling (Lesieur & Blume, 1987; Shaffer et al., 1997), although some researchers have suggested using higher cut-off score for different samples (Blaszczynski, Huynh, Dumlao, & Farrell, 1998; Dickerson, Baron, Hong, & Cottrell, 1996). Despite its popularity, various shortcomings of the SOGS have been identified. First, it tends to over-estimate gambling problems when lifetime estimates are used, as about one third of the ever-afflicted individuals have already resolved their gambling problems during the survey period (Shaffer et al., 1997). Second, it tends to yield inflated prevalence estimates with high false positives relative to DSM criteria when used with community samples (Shaffer et al., 1997). Third, some items are easily misinterpreted and subject to acquiescence bias (Ladouceur et al., 2000). For the present study, the SOGS was first translated from English to Chinese by local clinicians who were proficient in both English and Chinese, and then back- translated into English by independent researchers. The back-translated version was also compared with the original English version to determine the transliteral equivalence and to further refine the Chinese version. Minor changes were also

123 J Gambl Stud (2007) 23:145–156 149 made after pilot tested with problem gamblers. Clients responded to the SOGS items with ‘‘yes’’ or ‘‘no’’, and afﬁrmative responses were summed up to form a total score.

Data Analysis

We used the SPSS 13.0 computer software program (Chicago, SPSS Inc.) to conduct statistical analyses. Gender differences in categorical variables of demographic characteristics and gambling history were determined by Chi-square analyses (Table 1). A series of bivariate logistic regression analyses were then performed to investigate whether gender was predictive of each of the dichotomous variables of gambling activities, somatic/psychological symptoms, and gambling-related problems (Tables 2 and 3). Finally, variables with signiﬁcant Chi-square and bivariate logistic regression results (p < .01) were entered into a multivariate logistic regression to determine the most salient correlates of gamblers’ gender (Table 4). For all logistic regression analyses, we coded male gamblers as ‘‘1’’ and female gamblers as ‘‘2’’. Odds ratios greater than 1 implied that variables were more likely to be present in female than male gamblers, and vice versa for odds ratios less than 1.

Table 1 Demographic characteristics and gambling history of Chinese treatment-seeking problem gamblers

Male (N = 841) Female (N = 111) v2 N in category % N in category %

Age (years) 40.32** 18–29 160 19 13 12 30–39 295 35 27 24 40–49 252 30 37 33 50 or above 134 16 34 31 Education 67.83** Primary or below 110 13 47 42 Secondary 664 79 63 57 University or above 67 8 1 1 Marital status 70.16** Never married 235 28 13 12 Married 606 72 98 88 Employment status 86.84** Employed 690 82 46 41 Non-employed 151 18 23 21 Home-makers – – 42 38 Age of ﬁrst gambling (years) 116.10** 20 or below 521 62 29 26 21–29 252 30 46 41 30 or above 68 8 36 33 Duration of gambling 15.60* 0–5 67 8 17 15 6–10 135 16 19 17 Above 10 639 76 75 68 Amount of debt (US$) 5.91 Under 1,250 294 35 39 35 1,251–3,750 286 34 37 33 Above 3,750 261 31 35 32

* p < .01 ** p < .001 123 150 J Gambl Stud (2007) 23:145–156

Table 2 Gender differences in gambling activities and psychosomatic symptoms of Chinese treatment-seeking gamblers

Variables Male gamblers Female gamblers Odds 95% CI p ratioa NNwith % NNwith % variable variable

Gambling activities Engaging in casino gambling 841 463 55 111 78 70 1.93 1.26, 2.96 .00 Engaging in horse race betting 841 643 76 111 18 16 .06 .04, .10 .00 Engaging in soccer game betting 841 485 58 111 6 5 .04 .02, .10 .00 Engaging in mahjong gambling 841 303 36 111 67 60 2.70 1.80, 4.06 .00 Engaging in lottery 940 83 10 111 19 17 1.88 1.09, 3.24 .02 Somatic and psychological symptoms Reporting physical symptoms 839 205 24 111 45 41 2.11 1.39, 3.18 .00 Reporting psychological distress 839 647 77 111 91 82 1.35 .81, 2.25 .25 Reporting insomnia 839 350 42 111 57 51 1.48 .99, 2.19 .05 Reporting losing interest at work 839 271 32 111 25 22 .61 .38, .93 .03 Reporting suicidal ideations 840 128 15 111 26 23 1.70 1.01, 2.74 .01 a Odds ratios greater than 1 implied that variables were more likely to be present in female than male gamblers, and vice versa for odds ratios smaller than 1

Table 3 Gender differences in gambling-related problems on the South Oaks gambling screen

Variables Male Female Odds 95% CI p gamblers gamblers ratioa (N = 613) (N = 72) N with % N with % variable variable

Going back to win back lost money 383 63 49 68 1.28 .76, 2.26 .36 Claiming to be winning money when not 349 57 32 44 .61 .37, .99 .05 Feeling having a problem with gambling 587 96 66 92 .49 .19, 1.23 .13 Gambling more than intended to 582 95 67 93 .71 .27, 1.90 .50 Having people criticizing gambling behavior 578 94 69 96 1.39 .42, 4.65 .59 Feeling guilty about gambling 598 98 70 97 .89 .20, 3.92 .87 Wanting to stop gambling but could not 483 79 56 78 .92 .52, 1.70 .84 Hiding gambling from spouse, family etc. 472 77 48 67 .60 .34, 1.01 .05 Arguing over money spent on gambling 515 84 53 74 .53 .30, .94 .03 Failing to pay back borrowed money 439 72 49 68 .84 .50, 1.43 .53 Losing time from work due to gambling 303 49 31 43 .77 .47, 1.23 .31 Borrowing money to pay gambling debt from: Household money 380 62 51 71 1.49 .87, 2.54 .14 Spouse 304 50 37 51 1.08 .66, 1.75 .77 Other relatives or in-laws 384 63 46 64 1.01 .64, 1.75 .84 Banks, loan companies, or credit unions 490 80 39 54 .30 .18, .49 .00 Credit cards 445 73 39 54 .45 .27, .73 .00 Private loan agents 174 28 32 44 2.02 1.23, 3.32 .01 Cashing in stocks, bonds, or other securities 62 10 10 14 1.44 .70, 2.94 .33 Selling personal or family property 94 15 12 17 1.10 .57, 2.13 .77 Passing bad checks or overdrafts 30 5 3 4 .85 .25, 2.84 .79 a Odds ratios greater than 1 implied that variables were more likely to be present in female than male gamblers, and vice versa for odds ratios smaller than 1 123 J Gambl Stud (2007) 23:145–156 151

Table 4 Signiﬁcant results of a multivariate logistic regression analysis

B SE Odds ratioa 95% CI p

Being employed –3.02 .53 .05 .02, .14 .00 Gambling for more than 10 years –1.08 .46 .34 .14, .84 .01 Engaging in horse race betting –1.95 .44 .14 .06, .34 .00 Engaging in soccer game betting –1.84 .61 .16 .05, .52 .00 a Odds ratios greater than 1 implied that variables were more likely to be present in female than male gamblers, and vice versa for odds ratios smaller than 1. Variables with signiﬁcant differences (p5:01) in Tables 1–3 were entered simultaneously into the multivariate logistic regression analysis. Number of observations = 662, v2 = 229.25, R2 = .29, p = .00

Results

Demographic Characteristics

The current age of the sample ranged from 18 to 60 years. Table 1 shows that there were signiﬁcant gender differences in current age (v2 = 40.32, p < .001), educational attainment (v2 = 67.83, p < .001), marital status (v2 = 70.16, p < .001), and employment status (v2 = 86.84, p < .001). In particular, female as compared to male gamblers were more likely to be aged 40 or above (64% vs. 46%; Odds Ratio [OR] = 2.76, 95% conﬁdence interval [CI] = 1.80, 4.23) and be married (88% vs. 72%; OR = 2.89, 95% CI = 1.59, 5.26). Female as compared to male gamblers were less likely to have completed high school or above education (58% vs. 87%; OR = .21, 95% CI = .13, .32) and be employed (41% vs. 82%; OR = .05, 95% CI = .03, .08).

History of Gambling

Table 1 shows that female relative to male gamblers started gambling at an older age (v2 = 116.10, p < .001) and had a shorter duration of gambling history (v2 = 15.60, p < .01). In particular, female gamblers were more likely than male gamblers to start gambling after age 20 (74% vs. 38%; OR = 4.95, 95% CI = 3.16, 7.77), and were thus less likely to have a gambling history of more than 10 years (68% vs. 76%; OR = .65, 95% CI = .42, 1.00). Table 2 shows that gender was predictive of preference for various gambling activities (p < .001). Compared to male gamblers, female gamblers were more likely to engage in casino betting (55% vs. 70%; OR = 1.93, 95% CI = 1.26, 2.96) and mahjong gambling (36% vs. 60%; OR = 2.70, 95% CI = 1.80, 4.06); but were less likely to bet on horse races (76% vs. 16%; OR = .06, 95% CI = .04, .10) and soccer games (58% vs. 5%, OR = .04, 95% CI = .002, .10). There was no signiﬁcant gender difference on lottery gambling (p > .01).

Somatic and Psychological Symptoms

Table 2 shows that higher rates of somatic and psychological symptoms were noted among female than male gamblers (p<.01). Compared to male gamblers, female gamblers were more likely to report physical discomfort (24% vs. 41%; OR = 2.11, 95% CI = 1.39, 3.18) and suicidal ideations (15% vs. 23%; OR = 1.70, 95% 123 152 J Gambl Stud (2007) 23:145–156

CI = 1.01, 2.74). There was no signiﬁcant gender difference on psychological distress, insomnia, and loss of interest at work (p>.01).

Types of Gambling Problems

There was no significant gender difference in the amount of indebtedness as a result of gambling (v2 = 5.91, p>.01). About 1/3 of the present sample accumulated a gambling debt of over US$3,750, i.e., about 3–4 months’ salary of local blue-collar workers. The total score of the 20-item SOGS (Lesieur & Blume, 1987) was calcu- lated for each client, and t-tests between two independent samples yielded insig- nificant gender difference (t = 1.76, p > .01). With the exception of two men and one woman, all clients scored at or above 5 on this screening scale. Both male and female gamblers reported an average of 12 maladaptive behaviors or problems associated with their gambling. Table 3 shows that gender was predictive of three gambling-related problems on the 20-item SOGS (p < .01). The three significant items were related to ways of borrowing money to pay gambling debt. Compared to male gamblers, female gamblers were more likely to borrow money from private loan agents (28% vs. 44%; OR = 2.02, 95% CI = 1.23, 3.17), but were less likely to borrow money from banks and credit unions (80% vs. 54%; OR = .30, 95% CI = .18, .49) as well as from credit card companies (73% vs. 54%, OR = .45, 95% CI = .27, .73). Both male and female gamblers were similarly troubled by their indebtedness, inability to control their gambling behaviors, and gambling-related interpersonal problems (p>.01).

Multivariate Logistic Regression Analysis

Table 4 shows that when variables with signiﬁcant gender results (p<.01) were considered together, the most salient correlates of gender were: employment status (OR = .05, 95% CI = .02, .14), duration of gambling (OR = .34, 95% CI = .14, .84), preference for betting on horse races (OR = .14, 95% CI = .06, .34) and soccer games (OR = .16, 95% CI = .05, .52).

Discussion

Results of the present study showed considerable differences between Chinese male and female gamblers who sought treatment for problems associated with their gambling. Our findings were generally consistent with prevailing gambling literature based on Western samples (e.g., Crisp et al., 2004; Grant & Kim, 2002; Ladd & Petry, 2002; Potenza et al., 2001; Nelson et al., 2006; Tavares et al., 2001). For the present study, the most salient gender differences were noted in employment status, duration of gambling, and types of gambling activities. We found that compared to male gamblers, Chinese female gamblers started gambling at an older age, had a shorter duration of gambling, were troubled by similar number of gambling-related financial and interpersonal problems, and reported greater physical symptoms and suicidal thoughts. This shortening of the course toward dysfunction in female gamblers were also noted in Western female problem gamblers (Ibanez et al., 2003; Ladd & Petry, 2002; Nelson et al., 2006; Tavares et al., 2001). There are several plausible explanations to this faster 123 J Gambl Stud (2007) 23:145–156 153 progression to problem gambling and dysfunction in women. First, a genetic explanation has been proposed in terms of female biological vulnerability to problem gambling (Perez, Ibanez, & Torres, 1997). Second, female as compared to male gamblers are more likely to live with someone who also has current gambling problems (Ladd & Petry, 2002; Nower & Blaszczynski, 2006). It is thus more difficult for female gamblers to remove themselves from cues or inducement to gambling activities, and their home settings are more likely to be unstable and stressful. Third, the negative impact of gambling may be more readily felt or reported by female than male gamblers. Potenza et al. (2001) also found that among American problem gamblers using a gambling help line, more female than male gamblers had received mental health treatment and reported suicide attempts. In the present study, we found that female gamblers preferred casino and mahjong gambling, while male gamblers preferred betting on horse races and soccer games. In Western populations, female gamblers are also found to prefer gambling on slot machines and bingo than on cards, sports, and horse races (Crisp et al., 2004; Grant & Kim, 2002; LaPlante et al., 2006; Petry, 2003). These findings have been interpreted as reflective of gender differences in the motivation to gamble. Researchers (Brown & Coventry, 1997; Lesieur & Blume, 1991; Potenza et al., 2001; Trevorrow & Moore, 1998) have argued that male gamblers prefer strategic forms of gambling such as sports gambling to seek ego enhancement through the thrill of competitive risk taking, while female gamblers prefer gambling activities that require fewer skills and have lower odds (e.g., slot machines and lottery) to escape from problems, troubled marriages, and loneliness. This may be of particular relevance for the current sample of Chinese female gamblers. Given that 65% of them were either non-employed or homemakers, gambling may offer them opportunities to engage in decision-making processes and to have access to economic independence, recreation, and social contact that are otherwise denied in their home settings. The present study also showed gender differences in securing loans to pay gambling debts among Chinese gamblers. Similar to Western gamblers (Ladd & Petry, 2002), Chinese male and female gamblers accumulated comparable amount of gambling debt. As the majority of Chinese female gamblers in this study were either homemakers or without employment, they would have difficulties in securing loans from banks, credit unions, or credit card companies to recover their gambling debt. They would have to turn to private loan agents, who would lend money to individuals without a credit line, albeit with a very high interest rate. Thus, women’s gambling debt accumulated very fast and approximated male gamblers’ level of indebtedness, even though female gamblers had a shorter gambling history and engaged in gambling activities that were with lower odds. This study has several limitations and its results should be interpreted with cau- tion. First, we collected data from a sample of Chinese treatment-seeking gamblers. Its findings may not be readily generalized to non-treatment seeking gamblers, as there may be differential experiences or perspectives relating to gambling that compel gamblers toward treatment. Second, this study was based solely on self- reports of gamblers, which may be subject to recall and social desirability bias, especially in regard to sensitive areas such as the amount of debt and gambling problems. Third, our results on gender difference may be undermined as we did not specify types of gambling activities available in casinos, which typically include card games that require skills and concentration (e.g., blackjack and poker) as well as 123 154 J Gambl Stud (2007) 23:145–156 machine games that depend mostly on luck (e.g., slots and roulette). Research based on Western samples has indicated that gender preference, gambling pattern, and severity of associated psychosocial problems vary between these two types of casino gambling activities (Petry, 2003). Fourth, we lacked instruments from which formal diagnosis of pathological gambling or other mental health disorders could be determined. To the best of our knowledge, there is not yet any published report on psychometric properties of the Chinese version of the SOGS. Thus, its reliability and validity remains unclear. Furthermore, the many short comings of using the SOGS should also be taken into consideration. These include the possibility of overesti- mating gambling-related problems, misinterpretation of items, and acquiescence bias (Ladouceur et al., 2000; Shaffer et al., 1997). In addition, data for this study were collected within a specified time period. Characteristics of treatment-seeking gamblers are likely to change over time when there are changes in gambling opportunities and available treatment services. Finally, researchers have also cautioned that gender alone may only contribute a small part in the development of problem gambling (LaPlante et al., 2006; Nelson et al., 2006). Future studies should aim to examine the complex, dynamic interplay among specific demographics, economic, individual, and social factors in influencing gambling pattern and problems for both genders. Despite the above limitations, the present study has a number of implications for treatment services for Chinese female problem gamblers. We found that the ratio of Chinese male-female gamblers seeking treatment was about 8:1, which is higher than the 4:1 male-female ratio of problem gamblers in the general population (Wong & So, 2003). Given Chinese female relative to male gamblers have a more rapid progression to dysfunction, experience greater somatic and psychological symptoms, and have fewer means to recover gambling debt, we thus recommend that more vigorous and innovative strategies should be devised to increase Chinese female gamblers’ participation in treatment programs. For example, more recent studies in the United States have suggested that female problem gamblers may be more amenable than males to utilize casino self-exclusion programs as a form of self-help, especially among those with a strong motivation to improve gambling-related marital disturbances (Nower & Blaszczynski, 2006). Perhaps this relatively new form of treatment should be introduced or integrated to current counseling services for Chinese female problem gamblers. We also argue that core components of treatment programs for Chinese female gamblers should include finance and debt manage- ment, coping with physical discomfort and suicidal thoughts, as well as mobilizing support of husbands and family members. Social service and mental health profes- sionals should also be equipped with knowledge to screen for problem gambling in their female clients for early detection and referral to gambling treatment programs. Last but not the least, there is a great need for further gender analysis in gambling research in Chinese societies. Special attention should be paid regarding the extent to which changing roles of Chinese men and women will impact on their vulnerability to problem gambling, pattern of progression and dysfunction, and models of effective treatment services.

Acknowledgement The investigators would like to thank the Caritas Addicted Gamblers Coun- selling Center in Hong Kong for facilitating data collection for this study.

123 J Gambl Stud (2007) 23:145–156 155

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