2006 California Problem Gambling Prevalence Survey August 2006 Final Report Submitted to: California Department of Alcohol and Drug Programs Office of Problem and Pathological Gambling Submitted by: Rachel A. Volberg Kari L. Nysse-Carris Dean R. Gerstein Table of Contents List of Tables and Figures ................................................................................ iv Acknowledgements ........................................................................................ vi Authorship ...........................................................................................vi Overview of Study ........................................................................................viii Executive Summary ........................................................................................ 1 Methods ................................................................................................... 2 Gambling in California.................................................................................. 2 Problem Gambling in California....................................................................... 2 Correlates of Problem Gambling ...................................................................... 4 Awareness of Problem Gambling Services and Barriers to Help Seeking ....................... 4 Directions for the Future............................................................................... 5 Introduction.................................................................................................. 7 The Mission of the OPG................................................................................. 8 Background to the 2006 Problem Gambling Prevalence Study ................................... 8 Definitions ................................................................................................ 9 Measuring Gambling Problems...................................................................12 The Role of Timeframe ...........................................................................13 Principal Study Questions .............................................................................14 Highlights of Previous Knowledge....................................................................15 Gambling Availability and Prevalence Rates: Is There a Link? .............................15 The Changing Face of Problem Gambling......................................................17 Natural Recovery ..................................................................................18 The Uses of Prevalence Research....................................................................19 Strengths and Limitations of the Study .............................................................20 Overview of Methods......................................................................................22 Ethical and Peer Review ..............................................................................22 Questionnaire ...........................................................................................23 Translation of the Questionnaire ...............................................................23 Language Line Interviewing ......................................................................23 Pretest...............................................................................................24 2006 CALIFORNIA PROBLEM GAMBLING PREVALENCE SURVEY I Survey Design ...........................................................................................24 Advance and Refusal Conversion Letters ......................................................24 Break-off Cases ....................................................................................25 Sample Disposition and Response Rate .............................................................25 Weighting and Imputation ............................................................................27 Statistical Analysis .....................................................................................28 Gambling in California ....................................................................................30 Gambling in the General Population ................................................................30 Patterns of Gambling Participation..................................................................32 The Demographics of Specific Gambling Activities ..........................................33 Considering Gender, Age and Ethnicity ........................................................38 Gambling Preferences.............................................................................38 Reasons for Gambling..................................................................................40 Attitudes Toward Gambling...........................................................................41 Gambling Expenditures ................................................................................42 The Relationship Between Expenditures and Revenues .....................................44 The Geography of Gambling in California ..........................................................45 Data Sources and Analytic Approach ...........................................................46 Geographic Distribution of Gambling ..........................................................48 Proximity and Awareness of Gambling Venues ...............................................50 Comparing Gambling in California with Other States ............................................51 Changes in Gambling Participation Since 1990 ....................................................52 Problem Gambling Prevalence in California..........................................................56 The NORC DSM-IV Screen for Gambling Problems (NODS) .......................................56 Prevalence Rates .......................................................................................59 Population Estimates..............................................................................60 Prevalence Rates Among Demographic Groups ...............................................61 Prevalence by Type of Gambling ................................................................63 Statistical Properties of the NODS...................................................................64 Item Analysis .......................................................................................65 The Geography of Problem Gambling in California ...............................................66 Comparing California with Other States ............................................................68 Changes in Problem Gambling Prevalence Since 1990 ...........................................69 Comparing Low-Risk, At-Risk, and Problem Gamblers: Univariate & Bivariate Analyses ...70 Demographics ...........................................................................................70 II 2006 CALIFORNIA PROBLEM GAMBLING PREVALENCE SURVEY Gambling Participation ................................................................................72 Past Year Gambling................................................................................72 Monthly Gambling .................................................................................74 Problem Gambling as a Proportion of Total Participation..................................75 Gambling Preferences and Reasons for Gambling.................................................76 Venues, Activities and Company ................................................................76 Reasons for Gambling .............................................................................78 Expenditures Among Low-Risk, At-Risk and Problem Gamblers.................................78 Proportion of Losses by Problem Gambler Type..............................................80 Physical, Mental, and Emotional Correlates of Problem Gambling.............................81 Physical and Mental Health ......................................................................81 Tobacco, Alcohol and Illicit Drugs ..............................................................82 Identifying Risk Factors for Problem Gambling ......................................................85 Statistical Modeling Approach........................................................................85 Results of Statistical Modeling .......................................................................86 Attitudes Towards, Awareness of and Involvement in Problem Gambling Services..........89 Attitudes Towards Problem Gambling ..............................................................89 Awareness of Problem Gambling Services ..........................................................91 Barriers to Treatment .................................................................................93 Summary and Conclusion.................................................................................95 Summary .................................................................................................95 Directions for the Future..............................................................................96 How Many To Plan For? ...........................................................................97 General Conclusions...............................................................................98 The ‘Reno Model’ and Monitoring over Time .................................................98 References ...............................................................................................