The recent emergence of gambling problems among youth around the world is alarming. For those most vulnerable in our society, children and adolescents, problem gambling presents a serious public health concern. Our current knowledge and understanding of the magnitude of the problem and its considerable impact upon the well-being of youth compels us to respond in a timely and effective manner. A general public health paradigm to gambling, originally articulated by Wynne (1997) and Korn and Shaffer (1999), highlights the importance of such an approach. However, a conceptual model and framework to understand and specifically address youth problem gambling within a public health framework is needed. This article articulates a theoretical framework and model that will help facilitate the development, implementation and evaluation of a comprehensive, multi-level health promotion and prevention strategy for youth problem gambling.

A general public health paradigm to gambling, originally articulated by Wynne (1997) and Korn and Shaffer (1999), highlights the importance of such an approach. However, a conceptual model. 2010 Arizona Youth Gambling Profile Report. Other Surveys. A growing number of states are adding gambling questions to similar surveys. Two states that ask the identical question Arizona has added are Delaware and Nebraska. Delaware www.dcgp.org. Public Health Perspective on Youth Gambling: Youth Gambling: A public health perspective.

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Abstract

Introduction

The recent growth of gambling problems among youth around the world is alarming. Researchers, clinicians, educators and the public have only begun to recognize the significance of this risky adolescent behaviour. With the continuous rise in gambling technology and the expansion of the gambling industry, more gambling opportunities exist today than ever before.

Method

The literature on gambling and youth was reviewed.

Results

Given the greater accessibility, availability, and promotion of gambling, more and more youth have become attracted to the perceived excitement, entertainment, and financial freedom associated with gambling. While Internet gambling is a recent phenomenon that remains to be explored, the potential for future problems among youth is high, especially among a generation of young people who have grown up with videogames, computers, and the Internet.

Conclusion

Our current knowledge and understanding of the seriousness of gambling problems, its magnitude, and its impact on the health and well-being of children and youth compels us to respond to these new forms of gambling in a timely and effective manner.

Résumé

L’accroissement des problèmes reliés au jeu chez les jeunes du monde entier est inquiétant. Les chercheurs, les cliniciens, les éducateurs et le public lui-même commencent à reconnaître le sérieux d’un tel comportement à risque avec le raffinement des techniques de jeu et le développement accéléré de cette industrie, il existe de plus en plus d’occasions de s’adonner au jeu. La literature sur la jeunesse et le jeu a été rééxaminée. Ainsi, à cause de l’augmentation des occasions et de la promotion du jeu, de plus en plus de jeunes sont attirés par l’excitation, l’aspect spectacle et le sentiment de pouvoir s’enrichir, attributs qu’ils accolent au plaisir du jeu. Bien que le jeu sur Internet soit un phénomène encore récent, le potentiel d’un nombre accru de problèmes chez les jeunes est élevé, particulièrement chez la jeune génération qui a grandi avec les jeux vidéo, les ordinateurs et l’Internet. La literature sur la jeunesse et le jeu a été rééxaminée. Nos connaissances actuelles et notre compréhension du sérieux des problèmes de jeu, leur fréquence ainsi que leur impact sur la santé et le bien-être des enfants et des adolescents nous forcent à trouver des réponses concrètes et efficaces à ces nouvelles formes de jeu.

INTRODUCTION

Today’s children and teens in North America are the first generation of youth to grow up in a society where a multiplicity of types of gambling exists, and gambling venues are not only widely available but also heavily advertised and promoted. Gambling, once considered to be associated with sin and vice is now generally perceived as a harmless adult entertainment and has become mainstream in our society. Although in Canada government regulated gambling is illegal for youth under the age of 18, a growing number of young people are gambling for recreation and entertainment (). With increased exposure to, and availability of regulated and unregulated forms of gambling, including the recent emergence of Internet gambling, more youth are succumbing to the temptation and pressure to engage in these activities (). There is a growing body of research suggesting that greater accessibility is related to increased gambling, increased money spent on gambling, and increased rates of problem gambling (Griffiths, 1995). Research in Canada, the U.S., and internationally suggests that approximately 80% of adolescents have participated in some form of gambling during their lifetime (see the review by the National Research Council, 1999 and meta-analysis by ).

Most alarming is evidence indicating that between 4–8% of adolescents between the ages of 12 and 17 have a very serious gambling problem, while another 10–15% are at-risk for developing a gambling problem (Derevensky & Gupta, 2000; ; National Research Council, 1999). Further, while there are some methodological issues involved in the measurement of pathological gambling for youth, there are consistent reports that the prevalence rates of probable pathological gambling in youth (4–8%) are considerably higher than rates of pathological gambling in the general adult population (1–3%) (; National Research Council, 1999).

Pathological gambling can be described as a continuous or periodic loss of control over gambling and is highlighted by irrational thinking and erroneous cognitions, a preoccupation with gambling and with obtaining money to gamble, continuation with gambling despite adverse consequences, and an inability to stop gambling despite having the desire to do so (American Psychiatric Association, 1994). Between 1984 and 1999 there was a significant increase in the proportion of youth who reported gambling within the past year as well as those who reported gambling-related problems (). Clearly, adolescents represent a particularly high-risk group and are vulnerable to the development of gambling problems (Derevensky & Gupta, 2000; National Research Council, 1999).

Research has demonstrated that problematic gambling among adolescents has been associated with a number of other mental health outcomes. From a clinical perspective, youth with gambling problems exhibit higher rates of depressive sympto-mology, increased risk of suicide ideation and attempts, higher anxiety (), as well as an increased risk of alcohol and substance abuse disorders (Hardoon & Derevensky, 2002; ). In addition, there are a multitude of negative behavioural, psychological, interpersonal, and academic problems associated with problem gambling. Among youth, problem gambling has been shown to result in increased delinquency and criminal behaviour, poor academic performance, higher rates of school truancy and dropout, and disrupted familial and peer relationships (Hardoon et al., 2002; Wynne, Smith, & Jacobs, 1996). Such negative outcomes have short- and long-term implications for the individual, for their friends and family, as well as for society at large (Derevensky, Gupta, Hardoon, Dickson, & Deguire, 2003). To date, few public awareness strategies and effective social policies have been initiated to address this growing public health concern.

Aided by technological advances in the gaming industry, new forms of gambling are continually appearing. Recent developments in the gambling world include such additions as on-line gambling, technologically advanced slot machines, electronic gambling machines, Video Lottery Terminals (VLTs), interactive television games, and telephone wagering (). Internet gambling in particular allows players to participate in a number of casino-type games in the privacy of their own homes. Internet gambling falls under the grey area of person-to-person wagering under the Canadian Criminal Code, thus, owning and operating an on-line gambling company is currently illegal in Canada. As such, most Internet gambling websites are housed in off-shore operations (Kelley, Todosichuk, & Azmier, 2001). Nonetheless, Internet gambling appears to be an incredibly profitable market, with several governmental agencies becoming actively involved in their operation (e.g., Holland, New Zealand, Australia). Estimates are that this has become a multi-billion dollar business, with more than 400 web-based Internet sites currently operating.

The proliferation of on-line gambling sites poses a new problem for youth. While other sources of gambling are, for the most part, strictly regulated and prohibited for underage children, the Internet provides an accessible and largely anonymous route to an otherwise illegal activity for young people. Researchers have highlighted the ease with which gambling websites may be accessed by young people as well as the visually enticing aspects of Internet gambling (; ). The reasons most often cited by youth for engaging in gambling are for entertainment, excitement and the possibility of winning money (). These reasons are similarly important for Internet gambling, as the Internet has become a popular form of entertainment among youth.

Many adult Internet websites offer free games and free practice sites available to anyone with access to a computer. As well, some sites now appear to cater specifically to adolescents and young adults who have spent much of their life in an era of electronic video games and computers. Such sites offer a multitude of games including blackjack, roulette, slots, poker, and other casino games virtually identical to real life casinos while others also accept sports wagering. With new sites appearing daily, researchers suspect that the distinction between gambling and gaming may be blurred by the on-line gambling industry in order to maximize future profits. For example, many gaming sites offer rewards in the form of “tokens” where players can trade in a given amount of tokens for a prize. Each player begins with a certain amount of free tokens and each game involves an initial wager and payouts if the player is successful. When combined with these factors, youth who play regularly on these free practice sites are prime targets as future players. Internet casino sites also have reward and loyalty programs which may be enticing to youth. Such programs include the possibility of earning redeemable points through playing. For example, many sites offer high initial deposit bonuses, while others guarantee bonuses of up to $20 per month for returning players. Often, players who refer a friend are awarded bonuses as high as $50. Some sites even provide “Bettor’s Insurance” programs which returns 10% of net gaming losses (Gambling Online, 2003). Casino games are interspersed with other, more innocuous games, each following the same basic theme. Graphics are often colourful and realistic sounds and images add to the excitement of the game. Many games also include multiple players so individuals can compete with each other on-line. Even when playing on these practice sites without money, Internet gambling is perceived as being engaging, exciting and exhilarating.

Off-shore gaming sites remain predominantly unregulated. Practically, for underage youth who continuously surf the Internet, this can translate into questionable marketing strategies such as “pop-up” advertisements encouraging players to access adult gambling sites. However, little is known about the number of young people actually accessing these sites. Nevertheless, it is clear that more and more youth are accessing the Internet. In Canada, for example, data collected from 5,682 youth, aged 9 to 17 years, indicates that 99% reported having used the Internet at least to some extent, and 79% reported having Internet access at home (Media Awareness Network, 2001). While 40% of secondary students reported using the Internet for playing/downloading games, 62% of elementary school age students did so similarly. Data from the 2000 Programme for International Student Assessment (PISA) indicates that 90% of 15-year-olds have computers at home, and that 48% reported playing games on the Internet, at least a few times per week (Willms & Corbett, 2003).

While it is difficult to ascertain how many young people are aware of Internet gambling sites and how many are spending time gambling on-line, only a small number of empirical studies have examined Internet gambling behaviour, and nearly all involved adults. The Canada West Foundation (1999) in a survey of 2,202 Canadians reported that less than 0.5% of gamblers had actually gambled on the Internet (Kelley et al., 2001). A more recent survey by Ialomiteanu and Adlaf (2001) examined the prevalence of Internet gambling in Ontario, using data obtained from random telephone surveys conducted by the Centre for Addiction and Mental Health Monitor 2000. Across a sample of 1,294 adults, approximately 5% of adults reported having engaged in Internet gambling during the past year, with slightly more women participating in on-line gambling (6.3%) compared to men (4.3%). Differences in prevalence rates may be attributable in part to increases in public access to the Internet. In the Canada West Foundation survey, the reason most frequently given for choosing not to gamble on the Internet was a lack of Internet access (Azmier, 2000). A more recent survey of adults seeking treatment at the University of Connecticut Health Centre found that 8.1% of participants had gambled on the Internet, with younger people significantly more likely to have experienced gambling on-line ().

With respect to youth gambling, Griffiths (2001) provides data from a small sample of 119 adolescents, aged 15 to 19 years of age, none of whom report having gambled on the Internet. However, 4% of youth reported that they would like to try Internet gambling. In contrast to U.K. youth, recent findings from Canada suggest that that at least 25% of young people with serious gambling problems and 20% of those at-risk for a gambling problem (defined by cut off scores on a screening measure) may be playing on-line using so-called “practice sites” where no money is needed to play (Hardoon, Derevensky & Gupta, 2002). Wiebe, Cox, and Falkowski-Ham (2003), using a small sample of adults similarly reported that while only 4.7% of individuals reported gambling on the Internet during the past year, participants with serious gambling problems were much more likely to report engaging in Internet gambling. It may be that amongst individuals at risk for developing a gambling problem, the Internet presents a special danger. While our current knowledge remains in its infancy and the prevalence rates are relatively low, researchers and clinicians are predicting greater abuse among youth as well as other high-risk groups including seniors and pathological gamblers.

Adolescents appear particularly vulnerable to the appeal of Internet gambling as they find gambling enjoyable (Dickson, Derevensky & Gupta, in press), are particularly attracted to the colourful, fast-paced videogame-like qualities, view themselves as highly intelligent, and perceive themselves as invulnerable to a gambling problem. These practice sites expose youth to adult games, encouraging them to practice and perhaps move on to ‘for money’ on-line casinos (Canada West Foundation, 1999). Fortunately, some barriers do exist including requiring a credit card in order to wager on these sites. However, these barriers are not impossible to overcome. Are these sites training a new breed of gamblers? Only time will tell, as regulation of these sites continues to be highly problematic.

Mental health professionals are only beginning to fully recognize the magnitude and impact of problem gambling amongst teens. Awareness of the risks and harm associated with gambling problems in youth and the public at-large is lacking. There is a growing need to examine and respond to gambling problems in adolescents from a prevention and public health orientation.

Concern over the growing burden of gambling to individuals, families and society has stimulated discussion of gambling as a social and public health policy issue. makes several recommendations within the Canadian context and proposes that provincial governments carefully assess the impact of gambling expansion on quality of life and balance the promotion of gambling with that of protecting the public from gambling-related harm. In addition, he suggests monitoring gambling advertising, especially with regards to youth, and adopting a harm-minimization approach in order to reduce the adverse health and social consequences of gambling.

Recently, Messerlian, Derevensky, and Gupta (2003) outlined four public health goals – denormalization, protection, prevention, and harm-reduction – that taken together describe action needed to address problem gambling in this young population. Denormalization, within the context of youth gambling, implies social denormalization, where society begins to question and assess underage gambling. Similar to the strategies used in tobacco prevention, denormalization can include drawing attention to the marketing strategies employed by the gambling industry, influencing social norms and attitudes on youth gambling, challenging current myths and misconceptions of Internet gambling among youth and the general public, and promoting realistic and accurate knowledge about gambling. Governments, industry and the public have a responsibility to protect children and adolescents from potentially harmful activities. This goal aims to protect youth from exposure to gambling products and promotion through effective institutional policy, government legislation and through a reduction in the accessibility and availability of all forms of regulated gambling to underage youth.

Prevention can consist of increasing knowledge and awareness of the risk of gambling (including on-line gambling on practice sites) among youth, parents, and professionals. Primary prevention strategies can be used to help promote informed decision-making and be incorporated into curriculum through interactive school-based prevention programs. As well, the implementation of health communication campaigns and community education forums are desirable goals.

Developing harm-reduction programs targeting those youth who are already gambling excessively, but who have not reached the level of pathological gambling, in order to prevent the progression of the problem is just one example of secondary prevention. This is of critical importance as the presence of pathological gambling has been suggested to be a risk factor for suicide (Bourget, Ward, & Gagne, 2003). Primary care providers and psychiatrists have an important role to play in screening for early identification of young problem gamblers in addition to screening for substance abuse problems. Further, their role can include providing brief intervention, referral and treatment services to youth exhibiting signs of problematic gambling behaviour.

There is a need to develop in-service training on youth gambling for health professionals working with youth. However, such strategies alone are insufficient as they do little to address the larger social and environmental determinants of gambling behaviour in our society. Public health action needs to include working on a population level as well as on an individual level, as it is the interplay of intra-personal and inter-personal factors together with institutional, community, and public policy factors that influences one’s propensity to develop a gambling problem (Messerlian et al., 2003). Governments, the industry and the public have a responsibility to protect youth from potentially harmful products and activities. Public policy should reflect the changing social climate and aim to protect youth from access to gambling products and exposure to gambling promotion.

Governments have a responsibility to develop socially responsible regulations and statutes on Internet gambling and to carefully assess their social policies concerning underage gambling in general. Furthermore, through public advocacy governments can be urged to strengthen legislation on advertising and marketing of gambling products to underage youth. Evidently, social policies need to balance public health interests with the gambling revenues accrued by government and industry.

The convenience and easy access to on-line gambling poses distinct enforcement issues. The primary concern with Internet gambling continues to be regulating access to both ‘for money’ sites (Griffiths & Parke, 2002) as well as to practice sites. Governments struggle with a lack of effective approaches to monitoring and regulating on-line gambling providers. In turn, providers grapple with self-regulation to prevent individuals, such as underage youth, from accessing their sites illegally.

There are predictions that Internet gambling will continue to soar with governments becoming more actively involved in the operation of these sites. Gambling has become not only a huge source of revenue for governments throughout the world but also an important public health issue. Health professionals and others working with adolescents will require more knowledge and resources in order to better respond to new and emerging needs. While further research is needed in the area of Internet gambling, raising the issue to the public fore will only serve to better prepare for, and prevent future problems.

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Public Health Perspective Definition