An analysis of problem gambling among the Finnish working-age population Castren

Background: Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied. Method: An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling. Results: A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling. Conclusion: Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored. * Correspondence: sari.castren@thl.fi Equal contributors Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Faculty of Behavioural Sciences, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland Full list of author information is available at the end of the article © 2013 Castrén et al.; licensee BioMed Central Commons Attribution License (http://creativec reproduction in any medium, provided the or Ltd. This is an Open Access article distributed under the terms of the Creative ommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and iginal work is properly cited. Castrén et al. BMC Public Health 2013, 13:519 Page 2 of 9 http://www.biomedcentral. com/1471-2458/13/519 Background Many people gamble as a leisure activity, though for some it turns out not to be a leisure with pleasure. Gambling problems cause severe negative consequences. A DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis for pathological gambling (PG) requires ‘persistent and maladaptive gambling behaviour’, as indicated by at least five of ten symptoms that are similar in content to the symptoms of substance abuse [1]. Problem gambling is a milder form of gambling and is indicated by at least three of the ten DSM-IV-TR diagnostic criteria [2]. Recent analysis by Williams, Volberg and Stevens [3] concluded that the standardized pastyear problem gambling [1] prevalence ranged from 0.5% to 7.6% with the average rate across all countries being 2.3%. According to their comprehensive report the lowest prevalence rates for problem gambling are in Europe, intermediate rates in North America and Australia and the highest in Asia. The current problem gambling rate in Finland is 2.7% [4]. To date there have only been three Finnish Gambling Prevalence Surveys [4-6]. The latest survey from 2011 revealed that 78% of the Finns had gambled over the past year, the most popular gambling activity being National Lottery (i.e. Lotto) with more than half of the Finnish population having gambled Lotto (74%). The next most popular game was scratch cards (37%) followed by slot machine gambling. Internet games (national and international) attracted 1% of the Finns. A vast body of research has found that certain sociodemographic characteristics are associated with the development of gambling problems. Explicitly, younger age, male gender and socio-economic status (e.g. lower level of education, unemployment, marital status) are associated with gambling problems [7-11]. Gambling problems often co-occur with substance abuse and nicotine dependence. Lorains et al. [12] metaanalysis of comorbid disorders in pathological and problem gambling revealed that the weighted mean effect size for substance use disorders was 57. %, for alcohol use disorder 17.2% and 60.1% for nicotine dependence. The availability and acceptability of legalized gambling has increased expansively over the past decades as noted by Lyk-Jensen [13]. This development has the potential to increase the prevalence of gambling problems. In addition to the availability of games, the types of games gambled also influence the development of gambling problems [14]. Globally, the utmost problems are associated with EMG’s, known as slot machines [14,15]. The same trend is seen in Finland: Finnish Gambling Clinic’s and Finnish Gambling Help Line – Peluuri’s annual reports [16] show that slot machine gambling is the most troubling type of game for help-seeking problem gamblers. In Finland there are unique opportunities to gamble, as slot machines, about 20 000 units, are freely dispersed in kiosks, restaurants, grocery stores, fuel stations and shopping centres. Availability, accessibility and acceptability of gambling is most likely to have a great impact on the overall gambling prevalence of the Finns. Our aims were to investigate the prevalence of problem gambling in the adult sample in Finland, and to describe socio-demographic characteristics, alcohol consumption and nicotine dependency on different severity levels of gambling, and to also investigate types and frequency of games gambled among the adult population.