Acculturation and the Help-Seeking Acculturation and the Help-Seeking Behaviour of Asian-Canadian Behaviour of Asian-Canadian GamblersGamblers

David Liang

August 13th, 2007

Rationale for StudyRationale for Study

Rise of legalized gambling Underutilization of gambling treatment services Asian Canadians – cultural susceptibility to

pathological gambling Cultural variables to underutilization of treatment

services Bidirectional measure of acculturation Measurement of informal help

AcculturationAcculturation

Two perspectives to the constructTwo perspectives to the construct- Unidirectional (assimilation model)Unidirectional (assimilation model)

Low AcculturatedLow Acculturated High Acculturated High Acculturated(Low dominant, high heritage)(Low dominant, high heritage) (High dominant, low heritage) (High dominant, low heritage)

- Bidirectional (integration model)Bidirectional (integration model)

Low dominantLow dominant High dominant High dominant

Low heritageLow heritage High heritage High heritage

The Current StudyThe Current Study

Bidirectional measure of acculturationMeasures of attitudes towards seeking

professional psychological help, as well as attitudes towards seeking informal sources of help

Measure of gambling severity

Research questionsResearch questions

How does bidirectional acculturation How does bidirectional acculturation influence attitudes toward seeking influence attitudes toward seeking professional help for gambling problems?professional help for gambling problems?

How does bidirectional acculturation How does bidirectional acculturation influence attitudes toward seeking informal influence attitudes toward seeking informal sources of help for gambling problems?sources of help for gambling problems?

MethodologyMethodology

ParticipantsParticipants

170 Asian-Canadian adults Well-educated (average 15.8 years of education, 43% had over 4

years of post-secondary education) Mostly middle-upper class Fluent in English 88% Canadian Citizens 71% Chinese, 8% Korean, 7% Vietnamese, 7 other ethnicities at

3% or less 57% female, 43% male 82% with no previous therapy experience On the CPGI- 35% no risk, 33% low risk, 28% moderate risk, 4% high risk

Inclusion criteriaInclusion criteria

Inclusion criteria: - East Asian or Southeast Asian descent- Recruitment posters and online

questionnaire clearly specified that participants must have engaged in gambling behaviour in the past 12 months

RecruitmentRecruitment

Internet recruitment (snowballing method)

- 166 participants

Psychology participant pool

- 4 participants

MeasuresMeasures

Demographics measure Vancouver Index of Acculturation (VIA; Ryder, Alden,

& Paulhus, 2000) Attitudes Toward Seeking Professional Psychological

Help Scale for Problem Gambling (ATSPPH-PG; Fischer & Farina, 1995; Hart & Frisch, 2006)

Attitudes Toward Seeking Informal Help Scale for Problem Gambling (ATSIH)

Canadian Problem Gambling Index (CPGI; Ferris & Wynne, 2001)

HypothesesHypotheses Hypothesis 1a: Acculturation to the Canadian culture (VIA

mainstream scores) positively predicts help-seeking attitudes towards professional psychological services (ATSPPH-PG scores) (above and beyond demographic variables and gambling severity)

Hypothesis 1b: Acculturation to the mainstream Canadian culture (VIA mainstream scores) negatively predicts help-seeking attitudes towards informal help (ATSIH-PG scores)

Hypothesis 2a: Acculturation to the heritage Asian culture (VIA heritage scores) negatively predicts help-seeking attitudes towards professional psychological services (ATSPPH-PG scores)

Hypothesis 2b: Acculturation to the heritage Asian culture (VIA heritage scores) positively predicts help-seeking attitudes towards informal help (ATSIH-PG scores)

ResultsResults

Correlational analysesCorrelational analyses

Pearson product moment correlationsBetween outcome variables (ATSPPH-

PG and ATSIH-PG) and key predictor variables

Between outcome variables and demographic variables

Correlation Table Key VariablesCorrelation Table Key Variables

1 2 3 4 5 6

1 ATSPPH-PG -

2 ATSIH-PG .273** -

3 ATSIH #1 .211* .302** -

4 VIA-M .186* .214** .161* -

5 VIA-H -.019 .075 .166* .125 -

6 CPGI -.335* -.160* -.061 -.050 .104 -

**p < .01, *p < .05

Correlations Between Demographic Correlations Between Demographic and Outcome Variablesand Outcome Variables

**p < .01, *p < .05

ATSPPH-PG ATSIH-PG

Age .167* -.024

Gender -.180* -.066

Years of Education .211** .083

SES Composite .095 .135

Generation status .041 .164*

English Proficiency .204** .155*

Previous therapy experience .131 -.064

Country of birth -.011 .099

Immigration status .031 .149

Years in Canada .105 .146

Number of Siblings .023 -.014

Hierarchical Regression ProcedureHierarchical Regression Procedure

Significant demographic variables entered in first step CPGI scores (gambling severity) entered in second

step VIA-M and VIA-H (Canadian and Asian

acculturation) entered in final step Outcome variables- Regression 1: ATSPPH-PG (professional help-

seeking attitudes)- Regression 2: ATSIH-PG (informal help-seeking

attitudes)

Hierarchical Regression – Hierarchical Regression – ATSPPH-PGATSPPH-PG

Variable B SE B β R² ΔR²

Step 1 .147***

Age .022 .010 .194*

Years of Education

.049 .026 .156

English Proficiency

.230 .069 .255**

Gender -.199 .069 -.219**

Step 2 .209*** .062**

CPGI -.385 .109 -.261**

Step 3 .218*** .009

VIA-M .039 .031 .104

VIA-H .003 .026 .008

***p < .001, **p < .01, *p < .05

Hypothesis 1a/1b- Hierarchical Hypothesis 1a/1b- Hierarchical MRA – MRA – ATSPPH-PGATSPPH-PG

B Beta Sig.

Age

Sex

English Fluency

Years of education

CPGI

VIA-M

VIA-H

.019

-.150

.158

.038

-.381

.039

.003

.170

-.165

.175

.121

-.258

.104

.008

.052

.031

.039

.150

.001

.911

.203

Hierarchical Regression – Hierarchical Regression – ATSIH-PGATSIH-PG

Variable B SE B β R² ΔR²

Step 1 .043*

Generation status .132 .077 .143

English Proficiency .083 .066 .106

Step 2 .071** .027*

CPGI -.217 .100 -.169*

Step 3 .089* .018

VIA-M .043 .029 .132

VIA-H .017 .024 .055

**p < .01, *p < .05

Hypothesis 2a/2b- Hierarchical Hypothesis 2a/2b- Hierarchical MRA – MRA – ATSIH-PGATSIH-PG

B Beta Sig.

Generation Status

English Fluency

CPGI

VIA-M

VIA-H

.126

.028

-.217

.043

.017

.136

.036

-.169

.029

.024

.116

.681

.032

.136

.478

DiscussionDiscussion

Hypothesis 1a/1b – Hypothesis 1a/1b – Canadian AcculturationCanadian Acculturation Hypothesis 1a: Acculturation to the Canadian culture (VIA

mainstream scores) positively predicts help seeking attitudes towards professional psychological services (ATSPPH-PG scores) (above and beyond demographic variables and gambling severity)

Hypothesis 1b: Acculturation to the mainstream Canadian culture (VIA mainstream scores) negatively predicts help seeking attitudes towards informal help (ATSIH-PG scores) (above and beyond demographic variables and gambling severity)

VIA-M not a significant predictor of ATSPPH-PG or ATSIH-PG – hypothesis 1a/1b NOT supported

VIA-M was significantly correlated with both ATSPPH-PG and ATSIH-PG

Interpretation of findings – Interpretation of findings – Hypothesis 1Hypothesis 1

Findings are inconsistent with previous research on acculturation and professional help-seeking

No research on attitudes toward seeking help from informal sources

Lack of variability in acculturation Significant shared variance between Canadian

acculturation and other culture-related variables in regression

ATSPPH-PG

Mainstream Acculturation

English Proficiency

.427**

.186* .202**

Shared Variance Between Cultural Shared Variance Between Cultural Predictors of ATSPPH-PGPredictors of ATSPPH-PG

ATSIH-PG

Mainstream Acculturation

English Proficiency

.427**

.214** .184*

Generation Status

.162*

.390***

.375**

Shared Variance Between Cultural Shared Variance Between Cultural Predictors of ATSIH-PGPredictors of ATSIH-PG

Hypothesis 2a/2b –Hypothesis 2a/2b –Heritage (Asian) AcculturationHeritage (Asian) Acculturation Hypothesis 2a: Acculturation to the heritage Asian culture

(VIA heritage scores) negatively predicts help seeking attitudes towards professional psychological services (ATSPPH-PG scores)

Hypothesis 2b: Acculturation to the heritage Asian culture (VIA heritage scores) positively predicts help seeking attitudes towards informal help (ATSIH-PG scores)

VIA-H not a significant predictor of ATSPPH-PG or ATSIH-PG scores – Hypothesis 2a and 2b NOT supported

VIA-H not correlated with attitudes toward help-seeking

Interpretation of Findings: Interpretation of Findings: Hypothesis 2Hypothesis 2 Inconsistent with previous research, however,

heritage acculturation is relatively understudied Identification to Asian culture may not be

significant factor influencing attitudes toward seeking help for gambling problems

Asian conceptualization of mental illness may differ from Westerners, but they may not differ in their conceptualization of the factors that motivate help-seeking for problem gambling

Asian cultural identification may not be as important as Canadian culture for present sample

Gambling Severity and Attitudes Gambling Severity and Attitudes Toward Help-SeekingToward Help-SeekingGambling severity was strongest predictor

for attitudes toward professional and informal help for problem gambling

Negative relationship – contrary to previous research

Gambling Severity and Attitudes Gambling Severity and Attitudes Toward Help-SeekingToward Help-Seeking

1.2

1.4

1.6

1.8

2

0 1 2 3 4 5 6 7+

ATSPPH-PGATSIH-PG

CPGI SCORE

Possible explanationsPossible explanations Prochaska and DiClemente’s transtheoretical model- Individual progresses through 4 linear stages of increasing readiness to

change a problematic behaviour- Early stages: Individual may actively deny problem exists, may feel

benefits of continuing gambling behaviour outweighs cost of seeking help, not motivated to behavioural change

- Later stages: Committed to behavioural change, takes direct action- Because present sample is from general community, vast majority of

present sample has not sought help for their gambling problem early stages of change

- Denial of problem and defense towards treatment may explain negative relationship between gambling severity and attitudes toward help-seeking

- Transtheoretical model predicts that individuals in later stages of change would have more positive attitudes toward help-seeking needs to be validated by future research with gamblers in treatment programs

Possible explanationsPossible explanations

Cultural characteristics of Asians- May utilize coping strategy known as avoidance

coping (Sheu & Sedlacek, 2004) Differentiation between gambling severity and

adverse consequences from problem gambling- Freyer et al. (2006) found adverse consequences

due to alcohol abuse to be significant positive predictor of attitudes toward seeking help for alcohol dependence, while alcoholism severity was not a predictor

English fluency and Attitudes English fluency and Attitudes Toward Help-SeekingToward Help-Seeking

1.3

1.4

1.5

1.6

1.7

1.8

1.9

2

Very fluent Fairly fluent Somewhatfluent

Not veryfluent

ATSPPH-PGATSIH-PG

English Fluency

English Fluency: InterpretationEnglish Fluency: Interpretation

Current findings consistent with previous research

English fluency not a predictor for ATSIH-PG because in informal support network similar language, similar ethno-cultural background

GenderGender

Predictor of ATSPPH-PG- Women had more positive attitudes toward professional help

than men - Consistent with previous research (Addis & Mahalik, 2003) May be problematic for PG because PG predominantly affects

men (NESARC, 2002) Reluctance by men to seek professional help may be due to

traditional masculine gender role However, gender not a predictor of ATSIH-PG Men may feel more comfortable discussing vulnerabilities with

social support network rather than a professional, and may also feel less obliged to uphold traditional gender role

Gender and Attitudes Toward Help-Gender and Attitudes Toward Help-SeekingSeeking

1.7

1.75

1.8

1.85

1.9

1.95

Female Male

ATSPPH-PGATSIH-PG

LimitationsLimitations

Characteristics of the sample- General population- Gambling severity- English proficiency- AcculturationSnowballing recruitment methodUse of Web-based questionnaires

Clinical ImplicationsClinical Implications

Insight to why professional treatment for gambling is so underutilized

Incorporation of transtheoretical model into treatment protocols

Gender

Future DirectionsFuture Directions

Inclusion of alternate cultural variables into the help-seeking model

Utilization of subscales of ATSPPH-PG and ATSIH-PG

Incorporation of transtheoretical theory into help-seeking model

Development of adverse consequences of gambling scale

ConclusionConclusion

Several findings are consistent with previous research, while other findings are not

The unexpected results indicate that influence of cultural variables and gambling severity on help-seeking attitudes are still not well-understood

Findings contributed some answers to the research literature, but also valuable questions to be addressed in future investigations