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THE POPULATION PREVALENCE of PROBLEM GAMBLING: Methodological Influences, Standardized Rates, Jurisdictional Differences, and Worldwide Trends

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THE POPULATION PREVALENCE of PROBLEM GAMBLING: Methodological Influences, Standardized Rates, Jurisdictional Differences, and Worldwide Trends 1 30024Ca1.2BelB2012 THE POPULATION PREVALENCE OF PROBLEM GAMBLING: Methodological Influences, Standardized Rates, Jurisdictional Differences, and Worldwide Trends Robert J. Williams, Ph.D. Professor, Faculty of Health Sciences, and Coordinator, Alberta Gambling Research Institute University of Lethbridge, Lethbridge, Alberta, Canada Rachel A. Volberg, Ph.D. President, Gemini Research Northampton, Massachusetts, United States Rhys M.G. Stevens, M.L.I.S. Librarian, Alberta Gambling Research Institute University of Lethbridge, Lethbridge, Alberta, Canada REPORT PREPARED FOR THE ONTARIO PROBLEM GAMBLING RESEARCH CENTRE & THE ONTARIO MINISTRY OF HEALTH AND LONG TERM CARE May 8 2012 2 Citation Williams, R.J., Volberg, R.A. & Stevens, R.M.G. (2012). The Population Prevalence of Problem Gambling: Methodological Influences, Standardized Rates, Jurisdictional Differences, and Worldwide Trends. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. May 8, 2012. http://hdl.handle.net/10133/3068 Contact Information Dr. Robert J. Williams Professor, Faculty of Health Sciences & Research Coordinator, Alberta Gambling Research Institute 3017 Markin Hall University of Lethbridge Lethbridge, Alberta, Canada T1K 3M4 403-382-7128 [email protected] Dr. Rachel Volberg President, Gemini Research PO Box 1390 Northampton, Massachusetts, United States 01061-1390 413-584-4667 [email protected] Rhys M.G. Stevens Librarian, Alberta Gambling Research Institute University of Lethbridge Lethbridge, Alberta, Canada T1K 3M4 403-329-5176 [email protected] Acknowledgments The authors would like to thank the anonymous external reviewers as well as Beverly West (Research Associate, University of Lethbridge) for their very helpful critiques of earlier versions of this document. Lauren Williams was also very helpful in collecting some of the data. 3 SUMMARY 5 INTRODUCTION 8 IDENTIFICATION AND COLLECTION OF ALL EXISTING PREVALENCE STUDIES 10 METHODOLOGICAL IMPACTS ON PROBLEM GAMBLING PREVALENCE RATES 13 Instrument and Scoring Thresholds used to Assess Problem Gambling 13 Time Frame used to Assess the Presence of Problem Gambling 22 Method of Survey Administration 29 How the Survey is Described to Potential Participants 33 Threshold used to Administer Questions about Problem Gambling 35 STANDARDIZED PROBLEM GAMBLING PREVALENCE RATES 36 DIFFERENCES IN STANDARDIZED PROBLEM GAMBLING PREVALENCE RATES BETWEEN 41 JURISDICTIONS National (Between Country) Differences 41 Australian State/Territorial Differences 42 Canadian Provincial Differences 42 U.S. State/Territorial Differences 42 CHANGES IN STANDARDIZED PROBLEM GAMBLING PREVALENCE RATES WITHIN 43 JURISDICTIONS OVER TIME Framing the Issue 43 Casino Employees 44 Proximity to Gambling Opportunities 45 Replication Studies 47 National Differences 52 Australian State/Territorial Differences 52 Canadian Provincial Differences 52 U.S. State/Territorial Differences 53 Summary of Changes Within Jurisdictions over Time 53 4 REFERENCES 57 APPENDICES 63 A. National Adult Prevalence Studies of Problem Gambling 63 B. Australian State/Territorial Adult Prevalence Studies of Problem Gambling 131 C. Canadian Provincial Adult Prevalence Studies of Problem Gambling 158 D. United States State/Territorial Adult Prevalence Studies of Problem Gambling 198 E. Demographic Correlates of Problem Gambling 265 F. Characterological and Environmental Correlates of Problem Gambling 267 G. Gambling Format Correlates of Problem Gambling 268 H. Problem and Pathological Gambling Measure (PPGM) 269 5 SUMMARY The primary purpose of the present research was to standardize problem gambling prevalence rates so as to facilitate comparisons between jurisdictions as well as within the same jurisdiction over time. The first step in this process was the identification and collection of all published and unpublished studies that involve a jurisdiction-wide adult prevalence survey of problem gambling. A total of 202 studies were conducted between 1975 and 2012. All pertinent information was extracted from each of these 202 studies and is reported in Appendices A, B, C, and D. These Appendices represent the most complete collection of problem gambling prevalence studies to date and will serve as a database for future researchers. In addition, the demographic, characterological, environmental, and gambling format correlates of problem gambling in these 202 studies are summarized and reported in Appendices E, F, G, and H. The second step in this process was the examination of the impact of methodological differences on obtained problem gambling prevalence rates. The main methodological elements influencing obtained problem gambling prevalence are: a) which assessment instrument is used; b) the time frame used to assess the presence of problem gambling (i.e., past year, lifetime); c) how the survey is described to prospective participants; d) how the survey is administered (i.e., face-to-face, telephone, self-administered); and e) the threshold criterion that determines when problem gambling questions are asked. The methodological approach (within each of these elements) that produced the most valid prevalence rate was identified, as well as weighting factors that could be applied to obtain rates that would have been obtained using the more valid approach. The third part of this report presents the results of applying these weighting factors to create standardized past year problem gambling prevalence rates for all studies. Between Jurisdiction Comparisons Depending on the specific country and the survey year, the standardized past year rate of problem gambling ranges from 0.5% to 7.6%, with the average rate across all countries being 2.3%. In general, the lowest standardized prevalence rates of problem gambling tend to occur in Europe, with intermediate rates in North America and Australia, and the highest rates in Asia. More specifically, the lowest standardized prevalence rates occur in Denmark, the Netherlands, and Germany. Lower than average rates are seen in Great Britain, South Korea, Iceland, Hungary, Norway, France, and New Zealand. Average rates occur in Sweden, Switzerland, Canada, Australia, United States, Estonia, Finland, and Italy. Above average rates occur in Belgium and Northern Ireland. The highest rates are observed in Singapore, Macau, Hong Kong, and South Africa. 6 Within Australia, the lowest standardized rates occur in Western Australia. Other states appear to have average rates. Sampling problems preclude definitive statements about the Northern Territory. Within Canada, the lowest standardized rates occur in Quebec and Prince Edward Island. Nova Scotia’s rates have also been below average. The rates in Alberta, New Brunswick, and British Columbia have tended to be slightly higher than average. Intermediate rates are observed in other provinces. No prevalence studies have been conducted in the 3 Canadian territories (Yukon, Nunavut, Northwest Territories). A total of 31/50 U.S. states have conducted a prevalence study of gambling, with these studies being more common in states with higher levels of gambling availability. For states where prevalence rates are available, lower than average rates have been obtained in Florida, Indiana, New Mexico, Wisconsin, Delaware, Kentucky, North Dakota, South Dakota, and Iowa. The prevalence rate in Puerto Rico is significantly higher than all other rates. Mississippi, Louisiana, and Nevada have also had higher than average rates, as did Minnesota and New Jersey prior to 1995. Intermediate rates have been obtained in all other states. Within Jurisdiction Comparisons The final part of this report focuses on within-jurisdiction changes in standardized rates over time. No significant changes in prevalence rates over time were observed in the countries of Estonia, Germany, South Korea, and Sweden. However, recent prevalence rates were significantly lower than earlier prevalence rates in Finland, Hong Kong, New Zealand, Singapore, and Switzerland. In contrast, recent rates were significantly higher than earlier prevalence rates in Great Britain, Iceland, and the United States. (The increased U.S. rate is partly due to the relatively early comparison years: 1998 versus 2000). In Norway, the prevalence rate in 2005 was significantly higher than previous rates in 1997 and 2002, as well as subsequent rates in 2007 and 2008. In Canada, the prevalence rate in 2002 was significantly lower than in 2000 and 2007 (which may be due to the lack of anonymity in the 2002 study). As indicated, the U.S. and Canadian results may be artifactual, and, in any case, the state and provincial changes over time in these two jurisdictions provide better data sets to evaluate whether significant changes have occurred over time. Within Australia, significant changes in prevalence rates over time were observed in all states and territories except Western Australia. In all cases except Victoria this change represented a significant decrease in recent years compared to earlier years. Within Canada, significant changes in prevalence rates over time were found in 7 out of 10 provinces. The failure to find significant changes in Newfoundland, Nova Scotia, and Prince Edward Island may be due to the recency of the survey year comparisons in the case of Newfoundland, and the small sample sizes used in the Nova Scotia and Prince Edward Island 7 studies. In all cases of significant change over time in the 7 other provinces, the changes represented decreases in
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