A health inequality examination of problem gambling, substance abuse, mental health, and poverty in the United Kingdom; A secondary analysis and stakeholder interviews
Authors: Turner Nigel E. , Trajtenberg Nicolas , Cook Steve , Sanchez de Ribera Olga , Shi Jing , Bowden-Jones Henrietta 
Published: January 2025

Purpose: This project is focused on the social determinants of health associated with problem gambling and examined gambling-related disparities and the determinants of negative health outcomes. Social determinants include social class education, ethnic group, age, and sex (Elton-Marshall, et al., 2017). The main aims of the study were as follows:
Aim 1: In this study, we used the large data set to determine subpopulations who are experiencing social inequity (e.g., youth, older adults, women, Black people and other minority ethnic groups, and people with low income; see Elton-Marshall, et al., 2017) to determine how much they are impacted by gambling.
Aim 2: We tested the data as an interaction model to see if there are disparities in the impact of gambling by sociodemographic variables. The analysis included tests of the factorial structure of the Problem Gambling Severity Index (PGSI) across subpopulations (e.g., young vs. old, low-income vs. higher income, and Scotland vs England).
Aim 3: In addition, we conducted interviews with a small number of key stakeholders who were treatment providers or administrators of problem gambling services to discuss the research findings and to help us understand the data and develop a dissemination plan.
Methodology: This project consisted of a secondary analysis of the “Gambling in England and Scotland, 2016: Combined Data from the Health Survey for England and the Scottish Health Survey.” We concatenated the data from 2012, 2014, and 2016. This study is a secondary analysis of a large data set. The project incorporated a series of statistical analysis including logistic regression, multinominal regression, cluster analysis and confirmatory factor analysis and to explore the relationship between gambling and social and demographic variables.
Results: Based on our analysis combining the DSM and PGSI, about half a percent of the adults in England and Scotland met the threshold for a severe gambling problem. In terms of gambling behaviors, the most common games were national lottery tickets, scratch cards, and other lotteries. As expected, social and demographic variables were both significantly associated with problem gambling. Significant social and demographic risk factors for problem gambling include sex (male), age (being younger, 25 to 34), marital status (being single or never married), social class (manual and routine labour), ethnic /racial group (Black or other), and education (lower levels of education). In addition, being a heavy drinker, a current smoker and having a lower level of Wellbeing were also related to problem gambling. Although the results suggest that people in Scotland gamble somewhat more often
especially on lotteries, Country (England vs. Scotland) was not associated with gambling problems. In terms of games played, according to the logistic regression, the largest association was for electronic gambling machines (EGMs), followed by Sports gambling and then online gambling. The interaction of games with sex is interesting suggesting that the male vs. female differences is smaller for EGMs and online gambling, but larger for sports gambling.
As Part of Aim 2, we tested the psychometric properties of the PGSI gambling inventory and found that the PGSI was a valid construct for measuring problem gambling in the United Kingdom (UK). Moreover, we found that the PGSI scale operated similarly for respondents from both England and Scotland, suggesting generalisability across the UK.
In terms of Aim 3, the key stakeholder interviews, most of the stakeholders felt that the reported frequencies were lower than they expected and questioned the accuracy of the prevalence estimates. Several stakeholders noted that some ethnic communities (Chinese, Muslims) were not adequately represented in the survey, and speculated that this was due to under reporting. Several stakeholders also suggested that the prevalence of gambling problems among women who gamble may be higher than males who gamble, however analysis did not support this view. In terms of directions for future research, the stakeholders suggested the need to better understand the impact of trauma on
gambling, the potential side effects of medication(s), and a more comprehensive examination of environmental factors during childhood that increase the risk of problem gambling during adulthood.
Overall, the stakeholders felt that the results provide useful information but note that more research is needed to better understand gambling problems. Finally, several stakeholders believed that both government and industry should do more to help reduce problem gambling; however, one stakeholder cautioned that over regulation could backfire and push gamblers to non-regulated gambling sites.
Conclusions: The results of this research provide a detailed examination of the association between problem gambling and the social determinants of health in the UK. In summary, the key findings are that social and demographic risk factors for problem gambling include sex (male), age (being younger, 25 to 34), marital status (being single or never married), social class (manual and routine labour), ethnic /racial group (Black or other), education (lower levels of education), are significant factors in determining problem gambling. In addition, being a heavy drinker, a current smoker and having a lower level of Wellbeing, more psychological distress, and a greater rate of mental health problems, were also related to problem gambling. This knowledge will help to inform public health strategies in the UK related to the prevention and treatment of gambling disorders, as well as the prevention of gambling-related harm at the population level and for different groups (e.g., age groups, income
groups, ethnic groups).
Implications:
1. Problem gamblers are more likely to have lower levels of education, were less likely to be in
managerial work, and in terms of ethnic group were Black or other.
2. Problem gamblers are physically healthy, but have an elevated risk of mental health problems,
have a poorer sense of well-being and are more likely to smoke or engage in heavy drinking.
3. The results found that country (England vs. Scotland) was not associated with differences in
gambling problems, however, people in Scotland gamble somewhat more often especially on
Lotteries.
4. In terms of Aim 2, the results suggest that the PGSI is a valid measure of gambling in the Great
Britain and that it is equally valid for both England and Scotland.
5. Non-problem gamblers appear to be a relatively healthy population and had the best scores in
terms of mental health and well-being, though the contrasts with non-gamblers were trivial.
6. Non-problem gamblers had a somewhat greater rate of smoking, heavy drinking and obesity
compared to non-gamblers suggesting they may have more health problems eventually. Effort
should be made to encourage more physical activity amongst recreational gamblers.