canadian low- risk gambling limits: new evidence and limitations shawn r. currie, ph.d. april 10,...
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Canadian Low-Canadian Low-Risk Gambling Limits: New Risk Gambling Limits: New
Evidence and LimitationsEvidence and Limitations
Shawn R. Currie, Ph.D.
April 10, 2010
Gambling in CanadaGambling in CanadaLegal in all provincesLegal in all provinces
76% of Canadians have gambled in the last year (Cox et al., 2005)76% of Canadians have gambled in the last year (Cox et al., 2005)
Gambling venues and opportunities include: Gambling venues and opportunities include:
87,000 electronic gaming machines (VLTs and slots)87,000 electronic gaming machines (VLTs and slots)
33,000 lottery outlets33,000 lottery outlets
250 race tracks250 race tracks
60 permanent casinos60 permanent casinos
25,000 licenses to run temporary bingos, casinos, raffles 25,000 licenses to run temporary bingos, casinos, raffles
Large and growing unregulated gambling market in Large and growing unregulated gambling market in
Internet gambling Internet gambling
Private poker hallsPrivate poker halls
What is Responsible Drinking?What is Responsible Drinking?
AbstainAbstain
Responsible Responsible drinking isdrinking is
• No more than 2 drinks No more than 2 drinks per dayper day
• 1 non-drinking day per 1 non-drinking day per weekweek
• Drink slowly, avoid Drink slowly, avoid intoxication, wait an intoxication, wait an hour between drinkshour between drinks
• Don’t drink if driving, Don’t drink if driving, operating equipment, operating equipment, pregnant, pregnant, othersothers. .
AlcoholAlcohol
abuseabuse
AlcoholAlcohol
dependencedependence
Consumption
What is Responsible Gambling?What is Responsible Gambling?
NoNo
gamblinggambling
Don’t gamble alone, for Don’t gamble alone, for money for basic needs, money for basic needs, with borrowed money, with borrowed money, chase loses, when chase loses, when drinking.drinking.
Responsible gambling?Responsible gambling?- Frequency?Frequency?- Amount?Amount?- Time spent?Time spent?
ProblemProblem
gamblinggamblingPathologicalPathological
gamblinggambling
Level of participation/gambling intensity
0
10
20
30
40
50
60
70
0.01 0.05 0.1 0.2 0.4 0.6 1 1.5 3 20
Perc
ent r
epor
ting
two
or m
ore
harm
s
Percent monthly income spent on gambling activities and harm
0.7
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
Rel
ativ
e R
isk
Average daily alcohol consumption and risk of all-cause mortality
Source: Alberta Gambling Prevalence Study (2002)
Source: Babor et al. (2003)Males 45 and over
Using National Population Using National Population Health Data to Develop Health Data to Develop
Responsible Gambling LimitsResponsible Gambling Limits
Consequences of Gambling Consequences of Gambling (assessed by Canadian Problem Gambling Index)(assessed by Canadian Problem Gambling Index)
Betting more than can afford to lose.Betting more than can afford to lose.
Gambling caused health problems, including stress/anxiety.Gambling caused health problems, including stress/anxiety.
Gambling caused financial problems.Gambling caused financial problems.
Borrowed money or sold anything to gamble.Borrowed money or sold anything to gamble.
Gambling caused interpersonal problems.Gambling caused interpersonal problems.
Others criticized your gambling.Others criticized your gambling.
Felt guilty about gambling.Felt guilty about gambling.
Felt you might have a gambling problem.Felt you might have a gambling problem.
Harms = Reporting 2 or more negative consequences.
0
10
20
30
40
Pro
po
rtio
n r
ep
ort
ing
tw
o o
r m
ore
ha
rms Males Females Total
NN
MalesMales 24722472 18411841 21012101 13421342 745745 435435
FemalesFemales 36793679 21532153 19701970 994994 476476 272272
Total Total 61516151 39943994 40714071 23362336 12211221 707707
CCHS-1.2 CCHS-1.2 Dollars spent per yearDollars spent per year
0
10
20
30
40
50
60
70
80
Pe
rce
nt
rep
ort
ing
tw
o o
r m
ore
ha
rms
EGM in EGM out Lottery Bingo Casino Instant win tickets
CCHS-1.2 CCHS-1.2 Frequency by type of gamblingFrequency by type of gambling
Comparison of CCHS-1.2 with AB, BC, Comparison of CCHS-1.2 with AB, BC, and ON dataand ON data
Daily
2-6 times/week
About once/week
2-3 times/month
About once/month
6-11 times/year
1-5 times/yearF
requ
ency
of a
ny
gam
blin
g
0 10 20 30 40Percent reporting two or more harms +/- 95% CI limit
Alberta OntarioBC CCHS
Performance of optimal cut-points across surveysPerformance of optimal cut-points across surveys
AB ONT BC CCHS-1.2Frequency
AUC .77 .67 .63 .81.81
Optimal cut-off 2 - 3X / month 2 - 3X / month 3 -5X / month 2 - 3X / month 2 - 3X / month
Sensitivity/specificity 92 / 57 61 / 67 65 / 57 88.3 / 5988.3 / 59
Dollars spent
AUC .89 .75 .74 .81.81
Optimal cut-off $80 / month $400 / year $11 - $50 /month $501-$1000 / $501-$1000 / yearyear
Sensitivity/specificity 82 / 84 61 / 82 73 / 67 78 / 7078 / 70
Percent gross income
AUC .91 .80 NA .79.79
Optimal cut-off 3% 1% 1%1%
Sensitivity/specificity 78 / 89 76 / 66 74 / 74 / 7474AUC = area under ROC curve, Swets (1988) guidelines
0.5 – 0.7 = ‘low accuracy’0.7 – 0.9 = ‘moderate accuracy’> 0.9 = ‘high accuracy’
Soliciting Expert OpinionSoliciting Expert OpinionSurvey Goals:Survey Goals:
(1)(1) ObtainObtain opinions from 171 gambling experts opinions from 171 gambling experts (researchers, clinicians, policy makers) on the (researchers, clinicians, policy makers) on the need for need for low-risk limits low-risk limits
(2)(2) Assess the face validity of CCHS-1.2 derived limitsAssess the face validity of CCHS-1.2 derived limits
0
5
10
15
20
25P
rop
ort
ion
of r
esp
on
ses
Veryconservative
2 3 4 Just right 6 7 8 9 Very liberal
Frequency: 2-3 times/month Dollars spent: $500 - $1000CAN/year
Percent income: 1% gross income
Face Validity of Proposed LimitsFace Validity of Proposed Limits
Source: Currie, S. R., Hodgins, D. C., Wang, J. el-Guebaly, N., & Wynne, H. (2008). In pursuit of empirically derived low-risk gambling limits. International Gambling Studies, 8, 207-227.
Limitations of the MethodLimitations of the Method
Insufficient data to develop game-specific low-Insufficient data to develop game-specific low-risk limitsrisk limits
Reliability of gambler’s self-reported expenditure Reliability of gambler’s self-reported expenditure in phone surveys is questionablein phone surveys is questionable
Lack of agreement on definition of harm in Lack of agreement on definition of harm in context of gamblingcontext of gambling
Retrospective accounts of gambling harm and Retrospective accounts of gambling harm and expenditureexpenditure
Analysis of Low-Risk Gambling Limits in the Analysis of Low-Risk Gambling Limits in the Leisure, Lifestyle, Lifecycle ProjectLeisure, Lifestyle, Lifecycle Project
Investigators:Investigators:Nady el-Guebaly, MD Nady el-Guebaly, MD David Hodgins, PhD David Hodgins, PhD Garry Smith, PhDGarry Smith, PhDRob Williams, PhD Rob Williams, PhD Don Schopflocher, PhD Don Schopflocher, PhD Rob Wood, PhDRob Wood, PhD
MethodMethod
Starting in 2006, longitudinal cohort study of over 1800 adolescents and adults living Starting in 2006, longitudinal cohort study of over 1800 adolescents and adults living in rural and urban Albertain rural and urban Alberta
Individuals in five age cohorts range from 13 to 65 years being followed for five yearsIndividuals in five age cohorts range from 13 to 65 years being followed for five years
The sample includes persons randomly selected from the general population and The sample includes persons randomly selected from the general population and persons considered at-risk for problem gambling based on certain criteria. persons considered at-risk for problem gambling based on certain criteria.
Data collection every 14 monthsData collection every 14 months.
Leisure, Lifestyle, Lifecycle Project: Demographics at Leisure, Lifestyle, Lifecycle Project: Demographics at Time 1Time 1
VariableVariable Total Adult Completes (N=1372)Total Adult Completes (N=1372)
NN %%
AgeAge 18-20 18-20 23-25 23-25 43-45 43-45 63-6563-65
315315341341403403313313
23.023.024.924.929.429.422.822.8
GenderGender MaleMale FemaleFemale
602602770770
43.943.956.156.1
LocationLocation CalgaryCalgary EdmontonEdmonton Grande PrairieGrande Prairie LethbridgeLethbridge
577577405405170170220220
42.142.129.529.512.412.416.016.0
Leisure, Lifestyle, Lifecycle Project: Description of Leisure, Lifestyle, Lifecycle Project: Description of Longitudinal Sample Longitudinal Sample (N=809)(N=809)
VariableVariable NN % (weighted)% (weighted)
AgeAge 18-20 18-20 23-25 23-25 43-45 43-45 63-6563-65
146146182182283283198198
2626272732321515
GenderGender MaleMale FemaleFemale
348348461461
50505050
EmployEmploy PT or FT PT or FTUnemployedUnemployed
587587222222
75752525
Health Health SmokersSmokers Good-excellent physical healthGood-excellent physical health Good-Excellent mental health Good-Excellent mental health
185185638638737737
191978789191
Inclusion criteria: • Adults (>17 years)• Participated in Time 1 and 2
Exclusion criteria: • No gambling at Time 1 and 2
Gambling above the Risk Limits at Gambling above the Risk Limits at Time 1 & Time 2 (~18 months)Time 1 & Time 2 (~18 months)
Low risk Low risk gambling gambling
limitlimit
Time 1Time 1 Time 2Time 2
Chi-Chi-squaresquare
NN % % (weighted)(weighted)
NN % % (weighted)(weighted)
> 1% income> 1% income 137137 12%12% 237237 23%23% 140.71*140.71*
> $500/year> $500/year 8787 7.5%7.5% 193193 18%18% 74.94*74.94*
> 2-3 > 2-3 times/monthtimes/month
168168 17%17% 226226 21%21% 88.65*88.65*
Any risk Any risk factorfactor
237237 23%23% 368368 36%36% 136.04*136.04*
* p < .0001
Gambling above the Risk Limits at Gambling above the Risk Limits at Time 1 & Time 2Time 1 & Time 2
0
5
10
15
20
25
30
35
40
Pe
rce
nta
ge
> 1% income > $500/year > 2-3 times/month Any low-risk limit
Time 1 Time 2
Cross-Sectional Data Time 1Cross-Sectional Data Time 1
Low risk Low risk gambling gambling
limitlimit
Weighted proportion Weighted proportion gambling gambling over limitover limit
who report harmwho report harm
Weighted proportion Weighted proportion gambling gambling under limitunder limit
who report harmwho report harm
Odds Odds ratioratio
Chi-squareChi-square(weighted)(weighted)
> 1% income> 1% income 31% 6% 7.3 65.09*
> $500/year> $500/year 43% 6% 11.7 94.71*
> 2-3 > 2-3 times/monthtimes/month
29% 4% 8.6 85.77*
* p < .0001
Change in Risk Category between Change in Risk Category between Time 1 & Time 2Time 1 & Time 2
N = 809 Gamblers
n = 400 Low risk at
T1 & T2(59%)
n = 175 Low risk (T1) to
High risk (T2)(19%)
n = 50 High risk (T1) to
Low risk (T2)(6%)
n = 184 High risk at
T1 & T2(16%)
Low risk = gambling below all risk limits
High risk = exceeds at least one low risk limit
Game preferences at Time 1 & Time 2 Game preferences at Time 1 & Time 2 (all gamblers)(all gamblers)
0
10
20
30
40
50
60
Pe
rce
nta
ge
VLTs or Slots Casino games Raffle Instant win Bingo
Time 1 Time 2
Game preferences at Time 1 & Time 2Game preferences at Time 1 & Time 2(gamblers shifting from low risk to high risk)(gamblers shifting from low risk to high risk)
0
10
20
30
40
50
60
70
80
Pe
rce
nta
ge
VLTs or Slots Casino games Raffle Instant win
Time 1 Time 2
p < .0001
p < .001
p < .01
p < .0001
Game preferences at Time 2Game preferences at Time 2 (gamblers who were low risk at Time 1)(gamblers who were low risk at Time 1)
0
10
20
30
40
50
60
70
80
Pe
rce
nta
ge
VLTs or Slots Casino games Raffle Instant win
Below all low-risk limits at Time 2 Exceeds at least one low-risk limit at Time 2
p < .0001
p = NS
p < .05
p < .001
Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on frequency of gamblingon frequency of gambling
Time 1
Low risk
< 2-3 times/mo
N= 637
(83%)
Time 2
High Risk
> 2-3 times/mo
N= 129
(23%)
Low Risk
< 2-3 times/mo
N= 507
(77%)
Harm
N = 22 (17%)
No harm
N = 107 (83%)
Harm
N = 55 (9%)
No harm
N = 452 (90%)
Χ2 = 3.21, p = .07
Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on percent of incomeon percent of income
Time 1
Low risk
< 1% income
N= 635
Time 2
High Risk
> 1% income
N= 136
(37%)
Low Risk
< 1% income
N=499
(63%)
Harm
N = 31 (23%)
No harm
N = 105 (77%)
Harm
N = 42 (8%)
No harm
N = 457 (92%)
Χ2 = 22.15, p < .0001
Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on dollars spenton dollars spent
Time 1
Low risk
< $500/yr
N = 722
Time 2
High Risk
> $500/yr
N= 137
(15%)
Low Risk
< $500/yr
N=585
(85%)
Harm
N = 31 (22%)
No harm
N = 106 (78%)
Harm
N = 59 (9%)
No harm
N = 526 (91%)
Χ2 = 13.53, p < .001
Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on any low risk limiton any low risk limit
Time 1
Low risk
on all limits
N = 549
Time 2
High Risk
on at least one limit
N= 175
(25%)
Low risk
on all limits
N=374
(75%)
Harm
N = 31 (18%)
No harm
N = 144 (82%)
Harm
N = 26 (7%)
No harm
N = 348 (93%)
Χ2 = 12.52, p < .001
Impact of Changing Risk Category on DSM Impact of Changing Risk Category on DSM Symptoms of Pathological Gambling Symptoms of Pathological Gambling
Change from Change from Time 1 to 2Time 1 to 2
CIDI-Gambling Time 2CIDI-Gambling Time 2(Mean symptom count)(Mean symptom count)
T-valueT-value SignifSignifHarmHarm No harm No harm DifferDiffer
Low risk to high Low risk to high risk (n = 175)risk (n = 175)
1.65 (0.43)1.65 (0.43) 0.13 (0.05)0.13 (0.05) 1.511.51 4.81 4.81 ** <.0001
Low risk to low Low risk to low risk (n = 374)risk (n = 374)
0.19 (0.19)0.19 (0.19) 0.07 (0.03)0.07 (0.03) .09.09 1.31 *1.31 * NSNS
Gamblers who shift from high risk to low risk Gamblers who shift from high risk to low risk on any low risk limiton any low risk limit
Time 1
High risk
on at least one limit
N = 234
Time 2
High Risk
on at least one limit
N= 184
(73%)
Low risk
on all limits
N=50
(28%)
Harm
N =59 (31%)
No harm
N = 125 (69%)
Harm
N = 10 (19%)
No harm
N = 40 (81%)
Χ2 = 3.41, p = 0.16
ConclusionsConclusions
Cross-sectional data:Cross-sectional data:
The risk curve method appears to be valid for identifying low risk The risk curve method appears to be valid for identifying low risk gambling limitsgambling limits
Limitations of current population data dictate that disseminating Limitations of current population data dictate that disseminating actual limits to public would be premature at this pointactual limits to public would be premature at this point
Longitudinal data:Longitudinal data:
Large number of people shift to higher risk gambling and begin to Large number of people shift to higher risk gambling and begin to experience more harmexperience more harm
Change from low-risk to high risk gambling based on exceeding the Change from low-risk to high risk gambling based on exceeding the quantitative limits is associated with: quantitative limits is associated with: - increased harmincreased harm
- preference for higher risk forms of gambling (EGMs, casino gambling, preference for higher risk forms of gambling (EGMs, casino gambling, instant win tickets)instant win tickets)
- more symptoms of pathological gambling.more symptoms of pathological gambling.