1 Oklahoma Association for Problem and Compulsive Gaming Project Summary Oklahoma Gambling Prevalence Study 16 February 2016 Presented by Rene Paulson, PhD Mindy Chandler, MA Prepared for Wiley Harwell – Oklahoma Association for Problem and Compulsive Gaming Mark Reynolds – Oklahoma Department of Mental Health and Substance Abuse Services John Hostetler – Oklahoma Department of Mental Health and Substance Abuse Services Contact Information For questions or concerns, please contact the following: René Paulson and Mindy Chandler Elite Research, LLC 9901 Valley Ranch, Parkway E., Suite 3075 Irving, TX 75063 Telephone: +1 (972) 538 - 1374 +1 (800) 806 - 5661 Fax: +1 (800) 806 - 5661 1 1 Email: [email protected] Email: [email protected] PROJECT DESCRIPTION In order to best serve the behavioral and rehabilitative needs of the residents of the state of Oklahoma, the OAPCG is conducting a gambling prevalence within the state. To date, no such prevalence study has been conducted in Oklahoma. Conducting such a study would assist the OAPCG in lobbying for additional funds and intervention resources on behalf of its residents. The prevalence study will be representative of the state in terms of demographics and social economics status, and would allow for analysis in terms of age, race/ethnicity, education level, and county. CURRENT SITUATION According to national diagnostics, up to 1.5%2 of the general population in the United States is speculated to have pathological gambling problem (individual states that have conducted their own prevalence studies have found rates closer to 5% and 7%3). Because no prevalence studies have been conducted in Oklahoma to date, applying the national percentage to the state’s population (3,850,560)4, it is estimated that close to 60,000 residents suffer from compulsive or problem gaming. According to the National Gambling Impact Study Commission, “access to a casino within 50 miles was associated with approximately double the rate of pathological gambling”5, which could indicate a compulsive or problem gaming issues for well over 100,000 Oklahomans. Individuals with this condition have been found to also suffer from substance use, mood, anxiety, and personality disorders – suggesting that “treatment for one condition should involve assessments and possible concomitant treatment for comorbid conditions”6. Because pathological and problem gaming is associated with concurrent psychiatric problems and due to the concentration of casino-gaming within the state, it is crucial to understand the prevalence of this issue in the state of Oklahoma as a public health need. Within the state of Oklahoma, there are over one hundred casinos, most of which are tribal-operated. Indian gaming continues to see a steady increase in growth, up 7% in 2014, with revenues growing three times faster than national Indian gaming revenues7. This growth, however, was slower than gaming- revenue increases generated by non-tribal operated facilities8. Both trends speak to ever increasing gaming numbers, which may correlate with an increase in problem gaming and comorbid conditions. The OAPCG is a non-profit dedicated to providing education and training regarding problem and compulsive gambling, increase public awareness within the state of Oklahoma about problems associated with problem and compulsive gambling, providing information about compulsive gambling to all concerned individuals, conducting research in areas related to this problem, and developing prevention and education programs for all Oklahoma residents. It is with this mission that the OAPCG is requesting a study of compulsive and problem gaming within their state in order to best serve the needs of their residents, supporting a greater public well-being. 2 National Academy Press. Pathological Gambling: A Critical Review. 1999 3 Sited from: http://govinfo.library.unt.edu/ngisc/reports/7.pdf 4 Sited from: http://quickfacts.census.gov/qfd/states/40000.html 5 Sited from: http://govinfo.library.unt.edu/ngisc/reports/fullrpt.html 6 Petry, N.M., Stinson F.S., Grant B.F. “Comorbidity of DSM-IV Pathological Gambling and Other Psychiatric Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.” Journal of Clinical Psychiatry, 66(5). May 2005. 7 Sited from: http://newsok.com/oklahoma-indian-gaming-revenues-continue-to-thrive-report- shows/article/3947171/?page=1 8 Sited from: http://www.tulsaworld.com/news/local/indian-gaming-revenue-rises-but-is-outpaced-by-nontribal- facilities/article_e43af712-b4d8-11e3-a822-001a4bcf6878.html 2 The ODMHSAS is responsible for providing services to Oklahomans who are affected by mental illness and substance abuse. In FY13, ODMHSAS provided services to approximately 187,000 individuals. Fewer than 5 percent require hospital care. The majority take part in mental health and substance abuse outpatient programs, targeted community based services, prevention efforts and educational initiatives. INSTRUMENT DEVELOPMENT The survey used in this study is based on the Problem and Pathological Gambling Measure (PPGM). Findings from a recent study published by Williams & Volberg (2013) suggest when considering an instrument intended to measure gambling prevalence among a population, the PPGM outperforms other highly utilized gambling measures such as the SOGS (South Oaks Gambling Screen), CPGI (Canadian Problem Gambling Index), and various other operationalizations of the DSM-IV. In order to be able to score the PPGM to the newly released DSM-V, Williams & Volberg provided in direct correspondence (October 25, 2014) the analogous DSM-IV and DSM-V questions. Given this, the PPGM was used as the backbone for the instrument and supplemented with additional questions from other instruments, including the CPGI and a 2013 Iowa-based gambling study. Demographic and recreation questions, along with several questions related to forms of abuse, knowledge of gambling help centers, and the inclusion of social 'online' gaming were included at the request of OAPCG to broaden the analysis possibilities. Finally, a four-item social desirability scale was included in the instrument to assess the truthfulness of participant responses. The Brief Social Desirability Scale (BSDS) has four questions, is valid and reliable and free from gender specificity. BSDS has the advantages of brevity and practicality. It can be used before administering attitudinal surveys and the results of the survey compared including and excluding those with high social desirability scores. The cut-off score can be set from anything > 2 (more than one socially desirable answer) to > 3 (more than two socially desirable answers) to exclude people with a high tendency towards social desirability from analysis. The exact cut-off level will depend on how important it is to get results of the other questionnaire from people who answer more transparently about their personal attitudes. As is the case with all brief scales, the BSDS is preferred in many test situations where the administration time is limited or subjects are unable to tolerate lengthy questionnaires and the related drop in reliability remains tolerable (Strahan & Gerbasi, 1972). Analyses in this report are based on removal so respondents with a social desirability score > 3. A pilot sample of 12 participants completed the survey to assess the anticipated time for completion, as well as the readability and understanding of the survey items. Average completion time was 19 minutes. Minor changes to questions and question order were made at this stage, as well as the addition of the item of year of birth to validate the age range of respondents. Interrater reliability of item subsets were all above acceptable ranges (Cronbach’s alpha > .72). The online version of the survey was created and tested with another sample of 8 participants. Based on their feedback, several matrices of related questions were combined to reduce repetitiveness and completion time. Average completion time for the online sample was 15 minutes. Interrater reliability of item subsets were all above acceptable ranges (Cronbach’s alpha > .79). See Appendix A for a copy of the full survey. See Appendix B for DSMIV, DSMV, and PPGM scoring syntax. 3 METHODOLOGY As part of the methodology, a minimum sample of 2700 was needed for a final usable sample of 2200 (95% confidence level, 3% confidence interval, based on a 1.5% prevalence rate) representative of the U.S. Census data for the state of Oklahoma. The sample will reflect the characteristic makeup of the state in gender, age, and race/ethnicity. A total of 3253 respondents were collected with a final valid sample size of 2636. There were three forms of participant recruitment. Past prevalence studies have focused collection using an addressed based sampling telephone survey. With the increase in the population with wireless only service9,10, new collection techniques must be considered to reach a diverse and generalizable sample. In addition, there is an increase in people younger than 35 years heavily involved in online social media11, thus an increasing need to include and test collection through online surveys and social media advertisement. To date, no known problem gambling studies have been conducted with social media recruitment. Research including online panelists suggests that an increased rate of problem gambling may be evident. Statistical comparisons will be made between participants from these collection methods. Many benefits of online data collection methods