This report was prepared by the Responsible Gambling Council (RGC) research team consisting of: Monica A. White, PhD.

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2 This report was prepared by the Responsible Gambling Council (RGC) research team consisting of: Monica A. White, PhD Phil Mun, PhD Nadine Kauffman, MA Christina Whelan, MSc Matthew Regan, MSW Jon E. Kelly, PhD We wish to acknowledge Anita Gupta, PhD, for assisting with the preparation of the report, and Jamie Wiebe, PhD, of Factz Research, for conducting and analyzing the focus groups and interviews. The Responsible Gambling Council (RGC) is an independent, non-profit organization committed to problem gambling prevention. RGC designs and delivers highly effective awareness programs and promotes the identification and adoption of best practices in problem gambling prevention through research and information dissemination.

3 TABLE OF CONTENTS LIST OF TABLES EXECUTIVE SUMMARY INTRODUCTION LITERATURE REVIEW EGM FEATURES 9 Speed of Play 9 Sensory Effects 10 Payment Methods 12 Payout Methods 13 Betting Options 14 EGM-based Inducements 15 Game Availability 16 Programmed Gaming Features 16 EGM-based Responsible Gambling Features (RGFs) 17 VENUE FEATURES 20 Venue Type 20 EGM Accessibility 20 Venue Conveniences 21 Venue Design 23 Advertising 23 Venue-based Harm Minimization Strategies 24 COMMUNITY ACCESSIBILITY FEATURES 25 Number of EGM Venues 26 Proximity of EGM Venues 26 EGM Caps 27 Number of EGMs per Capita (Density) 27 EGMs in Low Income Areas 28 KEY INFORMANT QUESTIONNAIRE METHODOLOGY 29 Participants 29 Response Rate 29 Questionnaire 29

4 TABLE OF CONTENTS SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING 30 Data Analysis Plan 30 Results 32 SECTION B: MODIFICATIONS TO REDUCE PROBLEM GAMBLING Data Analysis Plan 38 Results 39 FOCUS GROUPS WITH PROBLEM GAMBLERS METHODOLOGY 61 RESULTS 61 DISCUSSION FINDINGS 64 EGM Features 64 Venue Features 65 Community Accessibility Features 65 LIMITATIONS 65 SUMMARY & CONCLUSIONS REFERENCES APPENDIX 1: Key Informants APPENDIX 2: Key Informant Questionnaire APPENDIX 3: Open-ended Responses to Questionnaire APPENDIX 4: Complete Rankings of Contributors and Modifications APPENDIX 5: Focus Group Script APPENDIX 6: Counsellor Interviews APPENDIX 7: Counsellor Interview Script

5 LIST OF TABLES TABLE 1. Questionnaire Response Rates 29 TABLE 2. Most and Least Important EGM Contributors to Problem Gambling (Researchers) 32 TABLE 3. Most and Least Important EGM Contributors to Problem Gambling (Specialists) 33 TABLE 4. EGM Feature Thematic Mean Importance Scores (Researchers and Specialists) 34 TABLE 5. Most and Least Important Venue Contributors to Problem Gambling (Researchers) 35 TABLE 6. Most and Least Important Venue Contributors to Problem Gambling (Specialists) 36 TABLE 7. Venue Feature Thematic Mean Importance Scores (Researchers and Specialists) 37 TABLE 8. Community Accessibility Contributors to Problem Gambling (Researchers) 37 TABLE 9. Community Accessibility Contributors to Problem Gambling (Specialists) 37 TABLE 10. Most Effective EGM Modifications and Perceived Evidence Strength (Researchers) 40 TABLE 11. Least Effective EGM Modifications and Perceived Evidence Strength (Researchers) 41 TABLE 12. Most Effective EGM Modifications and Perceived Evidence Strength (Specialists) 42 TABLE 13. Least Effective EGM Modifications and Perceived Evidence Strength (Specialists) 42 TABLE 14. Most Effective EGM Modifications (Counsellors) 43 TABLE 15. Least Effective EGM Modifications (Counsellors) 44 TABLE 16. Most Effective EGM Modifications (Problem Gamblers) 45 TABLE 17. Least Effective EGM Modifications (Problem Gamblers) 45 TABLE 18. Quartile Ranking (1-4) of Select EGM Modifications by Key Informant Group 46 TABLE 19. EGM Modification Thematic Mean Effectiveness Scores (Total Sample) 47 TABLE 20. Most Effective Venue Modifications and Perceived Evidence Strength (Researchers) 48 TABLE 21. Least Effective Venue Modifications and Perceived Evidence Strength (Researchers) 49 TABLE 22. Most Effective Venue Modifications and Perceived Evidence Strength (Specialists) 50 TABLE 23. Least Effective Venue Modifications and Perceived Evidence Strength (Specialists) 51 TABLE 24. Most Effective Venue Modifications (Counsellors) 52 TABLE 25. Least Effective Venue Modifications (Counsellors) 52 TABLE 26. Most Effective Venue Modifications (Problem Gamblers) 53 TABLE 27. Least Effective Venue Modifications (Problem Gamblers) 53 TABLE 28. Quartile Ranking (1-4) of Most Effective Venue Modifications by Key Informant Group 54 TABLE 29. Quartile Ranking (1-4) of Least Effective Venue Modifications by Key Informant Group 54 TABLE 30. Quartile Ranking (1-4) of Select Venue Modifications by Key Informant Group 55 TABLE 31. Venue Modification Thematic Mean Effectiveness Scores (Total Sample) 56 TABLE 32. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Researchers) 57 TABLE 33. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Specialists) 58 TABLE 34. Community Accessibility Modification Effectiveness (Counsellors) 59 TABLE 35. Community Accessibility Modification Effectiveness (Problem Gamblers) 59 TABLE 36. Item Ranking of Community Accessibility Modifications by Key Informant Group 59 TABLE A1. Rank Order of Mean Importance Scores: EGM Contributors (Researchers and Specialists) 93 TABLE A2. Rank Order of Mean Importance Scores: Venue Contributors (Researchers and Specialists) TABLE A3. Rank Order of Mean Importance Scores: Community Accessibility Contributors (Researchers and Specialists) 94 TABLE A4. Rank Order of Mean Effectiveness Scores: EGM Modifications by Key Informant Group 95 TABLE A5. Rank Order of Mean Effectiveness Scores: Venue Modifications by Key Informant Group 97

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7 EXECUTIVE SUMMARY BACKGROUND In February 2006, the Saskatchewan Liquor and Gaming Authority (SLGA), the organization which regulates all video lottery terminals (VLTs) and slot machines, made a commitment to review its policies regarding electronic gaming machines (EGMs) and problem gambling. To inform their review, SLGA asked the Responsible Gambling Council (RGC) to conduct a broad-based exploration of Key Informant opinions regarding best practices in the management of EGMs. As a non-profit organization whose mandate includes investigation and dissemination of best practices, RGC not only agreed to conduct the research on behalf of the SLGA, it also agreed to contribute financially to the initiative. The relationship between EGMs and problem gambling is somewhat ambiguous. There is research to suggest that the speed of problem gambling onset is faster for EGM players than for gamblers who engage in other forms of gambling. This is corroborated by clinical studies that have shown that EGM gambling tends to be the most common form of gambling engaged in among individuals seeking treatment for problem gambling. However, EGMs are among the most accessible and predominant form of gambling. Thus, it has been argued that the greater number of EGM players creates the appearance of a concomitant greater number of EGM problem gamblers. The RGC analyzed their 2005 prevalence data on gambling and problem gambling in Ontario and found that EGM play was the strongest independent predictor of problem gambling, a finding that is supported by several other studies. Thus, while there may be inconclusive evidence as to whether or not EGMs lead to problem gambling, there is consensus in the literature that EGM use and problem gambling are strongly related. Numerous studies have attempted to shed light on the nature of the relationship between EGMs and problem gambling. For the purpose of this report, the variables that have been examined in many of these studies are classified into three general areas: 1) EGM features, 2) venue features, and 3) community accessibility features. Using these three areas as its framework, the present study assesses, via the opinion of various Key Informants, which features are most likely to contribute to problem gambling, and which modifications to these features are most likely to reduce EGM-related problem gambling risk. The report consists of a literature review of available research on the three framework areas, a survey of Key Informant opinion, focus groups with EGM problem gamblers, a discussion of findings and limitations, and, lastly, a summary and conclusion. LITERATURE REVIEW There is a growing body of research that has examined the structural characteristics of EGMs that may be associated with problem gambling. These characteristics include the machine s speed of play, sensory effects (e.g., lights and sounds), payment methods (e.g., bill acceptors, direct electronic fund transfers), payout methods (e.g., tickets, tokens), betting options (e.g., minimum and maximum bet sizes), EGM-based inducements (e.g., near-misses, prize advertisements), game availability (e.g., type and number of games), programmed gaming features (e.g., win frequency, payout rate), and EGMbased responsible gambling features (e.g., machine RGFs, time and money limits). In addition to the features directly associated with EGMs, some have hypothesized that the relationship between EGMs and problem gambling may be partly due to features of the venues that house the machines. That is, problem gambling could be associated with the type of venue in which one gambles (e.g., a hotel versus a casino), one s access to EGMs (which is affected by the number of EGMs in the venue, the hours of operation, etc.), conveniences offered by the venue (e.g., access to money and/or alcohol), the venue s design and advertising campaigns, and the harm minimization strategies undertaken by the venue to mitigate problem gambling. Lastly, at the broadest level, a third EGM-related area that has been identified as being associated with problem gambling is community accessibility. Features that have been discussed in the literature that pertain to a community s overall access to EGMs include the number of EGM venues, proximity of EGM venues, EGM caps, number of EGMs per capita, and EGMs in low income areas.

8 KEY INFORMANT QUESTIONNAIRE Key Informants from Canada and abroad were invited to complete a questionnaire on EGM-related problem gambling. Informants consisted of problem gambling Researchers, identified through the published literature and/or personal referral; gaming and problem gambling Specialists (i.e., health and problem gambling professionals, regulators, operators), identified through gambling governing bodies and/or personal referral; problem gambling Counsellors, recruited through addiction agencies and/or personal referral; and EGM Problem Gamblers themselves, recruited through problem gambling services. The questionnaire was divided into two main sections. Section A looked at the contributors to problem gambling, and asked Researchers and Specialists to indicate their thoughts on the importance of select EGM features, venue features, and overall community accessibility features as contributors to problem gambling. Section B looked at modifications and asked all Key Informants to indicate their opinions on how effective select modifications to the above features would be in reducing the risk of problem gambling. Researchers and Specialists were also asked to indicate their opinion on the strength of the evidence supporting each modification. FOCUS GROUPS Two focus groups with EGM Problem Gamblers were conducted for this study: one in Regina, Saskatchewan, the other in Ajax, Ontario. Participants were first asked about their experiences with gambling and problem gambling. They were then asked, using the three framework areas as a guide, what they think it is that contributes to EGM-related problem gambling, and what they think could be done to reduce EGM-related problem gambling risk. DISCUSSION In reviewing the literature and synthesizing the opinions of a cross-section of Key Informants for the present study, a number of findings emerged which identified potential EGM-related contributors to problem gambling, as well as possible modifications to reduce problem gambling risk. EGM Features that Contribute to Problem Gambling With respect to EGM features, the Researchers and Specialists regarded fast speed of play, direct electronic fund transfers (which allow patrons to access bank or credit card funds directly while sitting at an EGM), the appearance of near-misses, and bill acceptors as the most important contributors to problem gambling. The importance of these items was supported by a thematic analysis which showed that features that speed up play (e.g., short time intervals between bet and outcome), involve payment methods (e.g., bill acceptors), and give the appearance of near-misses were rated much higher in importance than other EGM features. EGM Modifications to Reduce Problem Gambling Consistent with the finding that Key Informants identified direct electronic fund transfers and bill acceptors at EGMs as among the most important contributors to problem gambling, the elimination of these features was ranked among the modifications most likely to be effective in reducing problem gambling risk. Key Informants also endorsed mandatory player registration, the use of smart cards, the optional or (preferably) mandatory setting of pre-determined spending limits, and on-screen running cash totals of the amount spent during an EGM session. There is little doubt that the Key Informants were very optimistic about the potential of smart card technology to address problem gambling. However, this endorsement needs to be assessed within some limitations of the present study. Since no definition of smart card technology was provided to Key Informants, it is not possible to know what specific aspects of the technology they were endorsing. Smart card is to some degree a global term, which can incorporate a variety of features such as card-based access controls, playercontrolled self-limits, provider-controlled self-limits, and self-exclusion. From a broader perspective, the thematic analysis indicated that Key Informants believed that modifications aimed at limiting the amount of money spent and restricting payment methods were most likely to reduce problem gambling risk. However, although the Researchers rated speed of play and the appearance of near-misses as important contributors to problem gambling, they did not consider reducing the speed of play or the appearance of near-misses as effective as reducing the potential for overspending. Overall, Key Informants were more supportive of modifications to spending and ac-

9 cess to funds, rather than in modifications that might dampen the emotional experience and excitement of playing on EGMs. Venue Features that Contribute to Problem Gambling According to the Researchers and Specialists in this study, the most important venue-related contributors to problem gambling were having ATMs located either on the gaming floor or close to machines, 24-hour access to EGMs, and marketing that was targeted directly to the EGM player. Overall, easy access to money in venues (specifically via ATM machines) was considered a key contributor to problem gambling. Venue Modifications to Reduce Problem Gambling The venue modifications that Key Informants considered to be most effective in reducing problem gambling risk were prohibiting access to funds from credit cards at ATMs, disallowing cheque-cashing at venues, and removing ATMs from venues. As an alternative to removing ATMs, Key Informants expressed strong support for introducing other ATM restrictions, such as imposing tighter controls over withdrawal limits, a point that is also supported by research in the literature. Community Accessibility Features that Contribute to Problem Gambling Overall, the Community Accessibility features that Key Informants believed would be relatively more important contributors to problem gambling were those related to EGM distribution; that is, wide dispersion of EGMs throughout the community, large number of community venues housing EGMs, and convenient locations of EGM venues (e.g., close proximity to high residential populations). Community Accessibility Modifications to Reduce Problem Gambling Regarding modifications to community accessibility features, there was considerable variation among the four Key Informant groups such that there was no single item that all groups agreed would be the single most effective modification. However, the Key Informants as a group agreed that reducing the number of EGM facilities and centralizing EGMs to one or a few locations (preferably away from residential areas) would likely be the most effective community accessibility modifications. SUMMARY & CONCLUSIONS In a broad sense, Key Informants believed that certain features intrinsic to EGMs, such as the speed of play and appearance of near-misses, contribute to the risk of problem gambling. With respect to potential modifications, all Key Informant groups supported changes that did not directly involve the functioning of EGMs, but focused instead on the management of money, pre-commitment, the use of smart card technology, and restricting community access. The Management of Money The management of money emerged as an important issue related to problem gambling, as many of the highest ranked items and the thematic analysis focused on the on-screen display of money, access to money through ATMs, cheque-cashing, direct electronic fund transfers, and the setting of spending limits. One of the most consistent opinions to emerge from this study regarding effective modifications pertained to limiting a player s access to funds. Key Informants felt that restricting direct electronic fund transfers from credit and debit cards would be beneficial in reducing the risk of problem gambling. Pre-commitment Pre-commitment constitutes the creation of pre-set spending or time limits that are established prior to the start of a gambling session. There was considerable support among Key Informants for the creation of pre-commitment initiatives for gamblers, specifically for self determined, pre-set limits concerning the amount of money gamblers could spend in a given EGM session. It should be noted that Key Informants also felt that the concept of pre-commitment would be more effective in practice if it were to be a mandatory requirement for gamblers rather than optional. The Use of Smart Card Technology The mandatory registration and use of smart cards was one of the study s most highly endorsed modifications for reducing problem gambling risk. While the questionnaire did not provide an extensive opportunity for Key Informants to elaborate on the type of smart card system that they had in mind, the Informants appeared to understand that it involved a universal registration system and a requirement to have a card for machine access. Given that smart card systems can vary significantly in nature (e.g., by their time and money spending 5

10 limits, optional/mandatory features, types and levels of enforcement), Key Informants would likely have varying views on the breadth and comprehensiveness of such systems. Restricting Community Access In terms of community accessibility, although there was relatively strong support for all the modifications examined, the study seemed to suggest that the Key informants overall preferred restrictions on the number of EGM venues and the centralization of machines within a community as the most effective modifications for reducing the risk of problem gambling. Other Notable Observations Among the Key Informants, Researchers and Specialists were asked to assess the strength of evidence for each EGM, venue, and community accessibility modification item. Overall, there were low levels of confidence in the strength of the current evidence base. There was also little connection between the Key Informants perception of evidence strength, and the strength of the evidence found in the literature. The literature reviewed for this study demonstrated that the current knowledge base regarding ways to reduce EGM-related problem gambling is limited and incomplete. Most working in the field agree that a strong relationship exists between problem gambling and EGMs. Less clear is the question of how best to address this relationship. While research on the mechanics of EGMs provides insight into machine dynamics and player behaviour, such research offers less guidance as to what can be done to reduce problem gambling risk. This study gathers the opinions of some of those who have helped define the field and knowledge base in order to provide information that will be of assistance to policy-makers responding to the dilemmas posed by EGMs. In order for the findings of this study to be useful, however, they must be interpreted within a given jurisdiction s socio-political, geographic, and economic context. Implications and Future Directions 6

11 INTRODUCTION In February 2006, the Saskatchewan Liquor and Gaming Authority (SLGA), the organization which regulates all video lottery terminals (VLTs) and slot machines, made a commitment to review its policies regarding electronic gaming machines (EGMs) and problem gambling. i To inform their review, SLGA asked the Responsible Gambling Council (RGC) to conduct a broad based exploration of Key Informant opinion about best practices in the management of EGMs. ii As a non-profit organization whose mandate includes investigation and dissemination of best practices, RGC not only agreed to conduct the research on behalf of the SLGA, it also contributed financially to the initiative. BACKGROUND Controversy and debate have surrounded EGMs for the last 14 years. 4,5 The genesis of the controversy stems from Dr. Robert Hunter, a psychologist at Las Vegas Charter Hospital, who claimed that players of EGMs (particularly video poker) i EGMs such as VLTs and slot machines are technologically complex, but simple to use machines characterized by fast speed of play, bright colours, music, flashing lights, and random payout schedules. Whereas slot machines used to pay out in the form of cash, they now, similar to VLTs, may pay out in the form of tickets or tokens. 1 While in the past slot machines operated mechanically, today both slot and VLT machines have electronic operations. The only real difference remaining between the two types of machines seems to be the wider dispersal of VLTs in the community compared to slots, which are typically associated with casinos. Given their similarity and the fact that there does not appear to be any substantive research that differentiates between the two types of machines in terms of problem gambling outcomes, 2,3 no distinction was made between VLT and slot machines in the present report. Moreover, it is expected that the definition of what constitutes an EGM will be expanded in the future as machines grow together. bottomed out more quickly than those who played more traditional games. 4 This assertion was supported empirically by two studies which found that, among problem gamblers, the speed of problem gambling onset was faster for EGM players compared to players of other forms of gambling (such as cards, dice, horses, dogs, bingo and scratch cards). The authors of these studies speculated that the association between EGMs and problem gambling was due to the rapid, continuous and repetitive nature of EGMs. 6,7 Clinical studies also show that among problem gamblers seeking treatment, use of EGMs tend to be the most common form of gambling engaged in However, EGMs are also among the most accessible and predominant form of gambling. 15 In Canada, there are over 80,000 machines available across the country, generating by far the greatest revenue over all other forms of gambling. 16 Thus, it has been argued that the greater number of EGM players in the population makes it seem that there is a concomitant greater number of EGM problem gamblers. However, it may be that there are proportionally fewer EGM problem gamblers compared to problem gamblers who engage in other forms of gambling. 17 The RGC analyzed their 2005 prevalence data on gambling and problem gambling in Ontario and found that EGM play was the strongest independent predictor of problem gambling, even after controlling for gender, education, and other forms of gambling. 2 Similarly, results of an epidemiological study from Prince Edward Island found that among gambling activities VLT play had the strongest unique relationship to problem gambling. 18 EGM play, in comparison to other forms of gambling, was also found to be most highly related to problem gambling in Brazil, with EGM players not only displaying the greatest commitment to gambling, but also the most distress. 19 Thus, even though there is equivocation in the empirical evidence as to whether EGMs lead to problem gambling, there is consensus in the literature that EGM use and problem gambling are strongly related. Numerous studies have attempted to shed light on the nature of the relationship between EGMs and problem gambling. For the purpose of this report, the ii It is important to note at the outset of this report that the causes of problem gambling are complex. They involve a set of interactions between individual players, the game they are playing, and the environment they are playing in. Ultimately, the beliefs, attitudes, and behaviours of the individual player are the primary determinants of trouble-free gambling. However, the providers of gambling, like the providers of any product, have a responsibility to take action to limit any potential abuse or harm that may be related to the use of their product. The present report focuses exclusively on the informed opinion of best practices for the provision of EGM gambling, rather than on the best practices for the individual gambler.

12 variables that have been examined in many of these studies may be classified into three general areas: 1) EGM features, 2) venue features, and 3) community accessibility features. 1, Using these three areas as a framework, the present study seeks to determine which features are seen as most likely to contribute to problem gambling, and which modifications to these features may reduce EGM-related problems. Towards that end, the study reviews the available literature in the three areas and gathers the opinions of a cross-section of Key Informants; specifically, gambling and problem gambling Researchers, Specialists (i.e., health and problem gambling professionals, regulators, operators), problem gambling Counsellors, and EGM Problem Gamblers themselves. The report consists of the following sections: A literature review of the three EGM framework areas taken from academic research, governmental reports, and policy documents at both the national and international level (Chapter 1); A description of the questionnaire that was administered to Key Informants along with the questionnaire s findings (Chapter 2); The method and results of the focus groups that were conducted with Problem Gamblers (Chapter 3); A discussion of the study s main findings and limitations (Chapter 4); and finally, A summary and conclusion (Chapter 5). To ensure the quality, objectivity and integrity of the research, the present study was reviewed by an expert panel consisting of Dr. Harold Wynne (Wynne Resources Limited, Alberta), Dr. Nigel Turner (Centre for Addiction and Mental Health, Ontario), and Mr. Michael O Neil (South Australian Centre for Economic Studies, South Australia). RGC assumes full responsibility for the final content and conclusions of the report. 8

13 1 LITERATURE REVIEW EGM FEATURES In the literature, there is a growing body of research that has looked at the structural characteristics of EGMs that may be associated with problem gambling. iii Structural characteristics refer to features such as an EGM s speed of play, sensory effects, payment methods, payout methods, betting options, EGM-based inducements, game availability, programmed gaming features, and EGM-based responsible gambling features (RGFs). The research literature found on each of these features is discussed in turn below. Speed of Play Speed of play on an EGM refers to the time interval between successive plays on a machine. The shorter the time interval, the more frequently events (bets) can occur. EGMs are characterized as having an event every few seconds. This differs significantly from the lottery, for example, that occurs once or twice per week. It has been suggested that the faster the event frequency, the more likely it is that a gambling activity will lead to problems. 21 EGM speed can be broken down into two sub-features: reel spin speed and stop buttons. They are each discussed in turn. Reel Spin Speed Definition. Reel spin speed, measured in seconds, is the length of time elapsed for a slot machine s reels to complete a round of spinning. It reflects the time between the onset of a bet and its final outcome on a single round of play. iii A number of terms have been used in the literature to describe problem gambling. Aside from the term problem gambling itself, some of these terms include compulsive gambling, pathological gambling, probable pathological gambling, and disordered gambling. For the sake of simplicity, the term problem gambling will be used throughout this report. Association with problem gambling. Several studies in the literature have explored how reel spin speed affects gambling. One study conducted in Australian hotels and clubs with problem gamblers and non-problem gamblers examined the impact that certain EGM modifications, including reduced speed of play, had on player satisfaction, enjoyment, behaviour, and expenditure. Results revealed that both the non-problem and problem gamblers rated lower levels of enjoyment and satisfaction with the slower 5-second reel spin speed (lowered from 3.5 seconds). Rapid speed of play (i.e., 3.5 seconds) was not found to have any positive or negative impact on any of the parameters of play (i.e., time spent playing, number of bets, net loss), nor was it found to be related to problem gambling status, the severity of problems, or the amount of money spent. Notwithstanding these findings, it is not possible to tell from this study whether reductions in speed of play would be differentially effective for problem gamblers as compared to non-problem gamblers, as there were insufficient numbers of problem gamblers in the research. 24, 25 A second study examining manipulation of speed of play was conducted in a laboratory setting with non-problem and problem VLT gamblers. This study sought to determine participants self-reported reactions to the combined manipulations of speed and sound under three conditions: 1) decreased speed/no sound, 2) standard speed/standard sound (control condition), and 3) increased speed/standard sound. Results revealed that a reduction in the speed of play and the removal of sound altogether decreased ratings of enjoyment, excitement, and tension-reduction in the problem gamblers as compared to the non-problem gamblers. However, the lab setting, the small sample size, the reliance on self-report, and the confounding iv of sound and speed of play in the study limit the conclusions that can be drawn from the research. 22 Finally, in our review of the literature, another laboratory study was found which investigated the effects of VLT speed of play among a community sample (N = 43). The particular purpose of the study was to see if variations in speed of play had an impact on player concentration, motivation to play, loss of control, and number of games played. Participants were randomly assigned to play either a high-speed (5-seciv In research, confounding occurs when variables of interest are not properly controlled for. This results in the researcher being unable to determine the impact of any one variable on the observed result, thereby limiting their ability to draw conclusions about cause and effect. 9

14 ond) machine (the typical speed that VLTs are played in the community where the study took place) or a low-speed (15- second) machine. Results revealed that gamblers who played the high-speed machine, as compared to those who played the low-speed machine, played more games and underestimated the number of games played. However, speed of play did not seem to have an impact on player concentration, motivation, or loss of control over time or money spent. The authors of the study concluded that speed of play does not seem to have an impact on occasional VLT gamblers, and that speed restrictions are not an important harm minimization strategy. 26 However, it should be recognized that there are some significant limitations to the study s generalizability. First, the study was conducted in a laboratory setting and thus may not apply to actual gambling venues. Second, given the absence of problem gamblers in the study, the findings cannot be used to predict what impact speed of play may have on actual problem gamblers behaviour. Stop Buttons Definition. Stop buttons are a feature found on many types of EGMs that allow gamblers to terminate the spinning of the machines reels rather than wait until they have run their full course. By controlling how long the reels spin, the gambler is in a sense controlling the machine s speed of play. For instance, if the natural spinning duration of the reels is five seconds but the gambler presses the stop button after two, the game will end three seconds earlier than it would have otherwise. While this may not have much of an impact on speed of play after a single bet is made, it could have a significant impact if the stop button is pressed consistently after two seconds over many sequential bets. Eventually, more games would be played within the same unit of time than would be played had the reels stopped on their own. Association with problem gambling. While a stop button allows players to influence to some extent their length of playing time, some players may mistakenly believe that, through the stop button, they may influence their chances of winning. A study looking at the effect of the stop feature among occasional, non-problem, VLT gamblers demonstrated that players developed the illusion that their chances of winning were improved when the stop feature was used. Specifically, 87% believed that stopping the reels would bring different symbols on the screen, 57% believed that they could control a game s outcome, and 26% believed that they could enhance their probability of winning when using the device. Conversely, those who played on a machine without a stop feature did not develop the illusion of control to the same extent. They also played significantly fewer games. 27 Since this study only focused on occasional, non-problem gamblers, however, the observed effects cannot be generalized to problem gamblers. A second laboratory study, though, did explore the effect of stopping the reels on VLT play with both problem and nonproblem VLT gamblers. Results revealed that irrespective of gambling status, players were bothered when they could not stop the reels and were more likely to choose to play a game in which they could. 22 There is also research from Nova Scotia that has looked at the effects of disabling the stop button feature as well as reducing speed of play. (It also examined two other modifications implemented in two separate phases: reduced VLT hours of operation and the removal of VLTs altogether from certain venues). Random sample surveys were conducted with the general adult population (N = 403) and VLT players specifically (N = 865) at each phase of the study to ascertain the effect of these initiatives. The authors of the study reported that disabling the stop button and reducing speed of play resulted in a reduction of spending for 14% of the total VLT player base, with problem gamblers decreasing their spending by an average of $219 per week. VLT players also reduced their playing time on the machines by an average of 211 minutes per week, with problem gamblers reducing their time spent playing by an average of 376 minutes per week. The study also found that 8% of VLT players shifted gambling activities as a result of the disabled stop button/reduced speed of play initiative, and that 40% were in favour of the stop button removal/reduced speed of play initiative. 28 It should be noted, however, that because modifications were implemented at the same time in this study, it is difficult to know which one, or whether their combination, lead to the observed outcomes. Sensory Effects Sound Effects Definition. Sound effects are programmed noises that EGMs make. They can include narration, background music, musical tunes after a win, and realistic noises such as the sound 20, 29 of coins falling into a tray. Association with problem gambling. It has been suggested in the literature that certain features of music may be associ- 10

15 ated with gambling behaviour. For example, the quality of the music that an EGM plays may be closely tied to the quality of the machine, which may be the primary reason why a gambler might select it to play on. The familiarity of the music may represent something special to the gambler, which may influence perseverance in the face of game complexity. The distinctiveness of the music may make the game more memorable to the player, which may facilitate further gambling. Finally, the sounds associated with winning might create the illusion that winning is more common than losing, since losing is not identified by 30, 31 music. A number of studies found in our review looked at the relationship between machine sound effects and problem gambling. In the first study, participants (N = 382) ranked 13 structural characteristics (e.g., sound, graphics, background/ setting, game duration, rate of play, etc.) for their importance to video game enjoyment. Results showed that almost twothirds of the sample said that realistic sound effects were the most important feature related to game enjoyment. For the purposes of this report, however, there are two noteworthy limitations to this study. First, it focused solely on video games, which are not an exact proxy for EGMs. Second, it did not report findings from problem, or even high frequency, players. That said, the authors of the study argued that the structural features of EGMs and video games are essentially the same, especially since many EGMs now use video game technology. The authors recognized, however, that the consequences of high frequency gambling are certainly greater than the consequences of high frequency video game playing. 29 The second study found in our review focused on adolescent gamblers. In this study, respondents (N = 50) were surveyed to find out which slot machine features were most attractive to them. Findings indicated that 30% of respondents felt that the aura of slot machines (their music, lights and noise) was one of their most attractive features. Furthermore, those identified as problem gamblers in the study reported feeling significantly more attracted to the aura of the machines than non-problem gamblers 32. A limitation of this study, however, is that the independent effect of each structural characteristic was not assessed. Another empirical study examined the effects of sound on persistence of EGM play. The researchers tested the length of time that participants spent playing an EGM simulator when sound effects made it appear that other gamblers were winning in the next room. Results revealed that those who heard the sound effects and perceived that other players were winning gambled for longer periods of time and spent more money doing so. These findings suggest that sounds do in fact influence, or encourage, extended and/or continuous play among EGM players. No mention was made in this study, however, of whether the impact of sound effects would be more pronounced for problem gamblers as compared to non-problem gamblers. 33 In terms of the impact that modifying EGM sound effects might have on problem gambling, the laboratory study reviewed earlier, which looked at reaction to speed and sound modifications with problem and non-problem VLT gamblers, is relevant. 22 Results of that study showed that a reduction in speed of play and the removal of sound altogether decreased ratings of enjoyment, excitement, and tension-reduction in problem gamblers as compared to non-problem gamblers. Note again, however, that speed of play and sound were confounded in this study, so one cannot know if the findings are due to one factor over the other or a combination of the two. No other studies exploring the independent effects of reducing sound volume or removing sound altogether from EGMs were found. Visual Effects Definition. Visual effects on EGMs can include flashing lights, 5, 20 primary colours, furnishings and iconology. Association with problem gambling. The literature on visual effects is quite limited and has not changed much in the last 13 years.31 One empirical study looking at the effect of coloured lighting on gambling behaviour found that non-problem gamblers placed more bets and lost more money when they were exposed to red, as compared to blue, lighting (presumably because red lighting is more arousing). 34 However, there was no inference as to whether this finding would be observed among problem gamblers as well. Interestingly, it has been noted that gambling venues in the USA and UK are often decorated with colours that tend toward the red end of the colour spectrum (i.e., black, red, purple). 31, 34 It has also been suggested that primary colours and flashing lights contribute to the air of fun and excitement of playing on an EGM. 34,35 In addition to the above observations, one other study can be mentioned here. It is the aforementioned questionnaire study of adolescent gamblers which found that 30% of the 11

16 sample claimed that the aura of slot machines (their music, lights and noise) was one of their most attractive features. Moreover, those identified as problem gamblers in the study reported being significantly more attracted to the aura of EGMs as compared to non-problem gamblers. 32 Recall, however, the limitations of this study: Due to the fact that the separate structural features of EGMs (e.g., their music, lights, and noise) were not investigated separately, it is difficult to determine which one was most attractive to respondents. Payment Methods Bill Acceptors Definition. Many EGMs are equipped with bill acceptors which allow dollar bills to initiate play, in addition to coins or tokens. Association with problem gambling. Bill acceptors on EGMs are convenient because they do not require gamblers to continually insert coins or tokens into the machines, or to have the exact amount of change or tokens to play. However, the insertion of a bill into a machine converts the full monetary value of that bill into game credits, thereby enabling faster, more continuous play. Indeed, one study was found in our review showing that coinless machines can speed up playing time by 15%, due to fewer breaks being taken to obtain proper change and less downtime being spent refilling coin hoppers. 36 The risk of problem gambling potentially increases with larger denomination bill acceptors because they effectively allow larger amounts of money to be converted into credits at one time. v While not specifically referring to problem gambling, the link between gambling expenditures and bill acceptors has been noted by policy analyst, Michael O Neil. He observed a positive relationship between the two variables in two Australian states: Victoria, where bill acceptors are allowed, and South Australia, where they are not. While recognizing that there are many factors involved in determining EGM gambling losses, O Neil reported that there was a significant difference between the two Australian states in this regard: In Victoria, net EGM gambling losses were over $A90,000 per machine, while in South Australia, they were over $A50, v Research on bill acceptors seems to be focused only on the relationship between denomination size and expenditure. No research was found in our review that explored limitations to preloading bill acceptors (e.g., inserting multiple bills at one time). The direct link between problem gambling and bill acceptors was identified in a different Australian study which showed that over 65% of problem gamblers often or always used bill acceptors, as opposed to 23% of non-problem gamblers. The authors of the study stated that the bill acceptors decrease the need for breaks, and thus the opportunity to reflect on gambling activity. 38 Similarly, a community survey (N = 755) found a strong relationship between being a regular or self-identified problem gambler and frequent use of EGM bill acceptors: compared to recreational gamblers, the majority of regular and problem gamblers always used bill acceptors. They also tended to use bill acceptors of larger denominations. 39 A study exploring the impact of limiting EGM bill acceptors to $20 was conducted in Queensland, Australia. Two methods of data collection were used. The first involved interviews with study participants (N = 359); the second involved an analysis of EGM revenues generated during the experimental period. Results revealed that 61% of those interviewed approved of the $20 limit, 28% believed that the limit should be reduced further, and approximately 20% reported changes in their behaviour, especially if they were at high risk for problem gambling (30-40% of high-risk problem gamblers reported a change in behaviour). Specifically, those who said they changed their behaviour reported spending less time and money gambling, reducing their bet size, and visiting the gaming venue less frequently. Interestingly, however, the concomitant revenue analysis indicated that implementation of bill acceptors did not lead to a significant loss of EGM earnings. The authors of this study recognized that the two sets of results were counterfactual, and suggested that either there was a discrepancy between participants reported and actual behaviour, or that estimates suggesting that problem gambling contributes significantly to gambling revenues are inflated. 40 A second study was found looking at the impact of modifying EGMs in a number of ways, including limiting bill acceptors to a maximum of $20. The study sample included recreational and problem gamblers frequenting clubs and hotels. The results revealed that while limited denomination bill acceptors (i.e., $20) reduced overall machine expenditure, recreational and problem gamblers did not differ in their rates of expenditure reduction. Moreover, though problem gamblers seemed to prefer using machines with higher denomination bill acceptors, the authors of the study concluded that the use 12

17 of high denomination bill acceptors was not independently associated with problem gambling status, severity of problem gambling, amount of money lost, or persistence of play when taking into account other factors such as age, gender, credits wagered per bet, and play rate. This conclusion was consistent with anecdotal reports obtained from problem gamblers in focus groups who indicated that limiting the denomination of bill acceptors would be unlikely to lead to changes in 24, 25 their patterns of play. A final study comes from Nova Scotia, which has 15 years of experience with bill acceptor equipped VLTs. An evaluation of patrons opinions about bill acceptors and VLTs found that non-problem and problem gamblers viewed bill acceptors as an effective method to assist with the management of time and money spent on EGMs, especially for players who set budgets for play. 41 Direct Electronic Fund Transfers Definition. Direct electronic fund transfers allow patrons to access bank or credit card funds directly while sitting at an EGM. This capability makes accessing funds far more convenient than the alternative, which is to step away from the EGM to obtain money from some other source (e.g., a nearby ATM). Association with problem gambling. When New Jersey regulators in 1996 agreed to let casino patrons use credit and debit cards to purchase gambling chips and slot tokens, problem gambling experts sounded alarm bells, stating that such technology would wreak havoc with some problem gamblers. They also argued that it would make even casual gamblers lose more than they had originally planned. 42 However, no empirical research was found in our review that explored the actual implications of placing direct debit technologies at EGMs. As well, no empirical research was found exploring the effectiveness of eliminating direct electronic fund transfers from machines. The apparent absence of this type of research may be due to the fact that direct electronic fund transfer technology is new and not yet widely practiced. Credit Displays/Credit Conversions Definition. Credit displays/credit conversions are not actually methods of payment; rather, they refer to what happens to payment immediately after it is inserted into an EGM. Because they are tied to payment, however, they are included in the Payment Methods section of our review. When money is inserted into an EGM, it is usually converted automatically into credits that are displayed on the machine and used to gamble. For example, if $5 were entered into a machine that operated with 2 cent credits, there would be a total of 250 credits displayed and made available. The display of money wagered in the form of credits is also called tokenization. 24 Association with problem gambling. While the ability to insert money into a machine to obtain credits may be a convenient feature (i.e., it saves the gambler from having to exchange money for tokens), it has been hypothesized that this could contribute to faster speed of play, since the gambler essentially has a running credit on the machine. It has also been hypothesized that a credit display instead of cash can contribute to misjudgements about how much money one is actually spending and, ultimately, increase the risk of problem gambling. 20 Aside from converting money into credit, EGMs can also convert wins into additional game credits, a feature which could further prolong play and, again, increase the risk that problems will occur. 1 While our literature review did not find any empirical evidence to support the above hypotheses, four related studies were found. The first two, conducted in the 1960s, found that gamblers tended to make more cautious decisions about wagers when they gambled with real money as opposed to credits. The implication of these studies is that an action, such as tokenization, which conceals the true value of money may also contribute to reduced caution in wagering decisions. 43,44 The third study found in our review showed that after tokenization was introduced in New South Wales, Australia, the largest annual increase in EGM expenditure was observed. 23 Finally, a study of players awareness of, and attitudes towards, modifications to VLTs found that players rated displaying cash totals instead of credits to be a highly effective modification for assisting them in keeping track of how much money they were spending. No differences were observed in this study, however, between non-problem and problem gamblers. 41 Payout Methods Tickets or Tokens Definition. The means of receiving one s payout or winnings from an EGM is entirely dependent on the design of the machine. Some machines (e.g., those with Ticket-In Ticket- 13

18 Out (TITO) technology) deliver the payout or winnings in the form of a ticket that must be redeemed by a cashier or machine. This technology is rapidly becoming the industry norm. Payouts can also be delivered in the form of tokens that must be redeemed by a cashier. The difference between ticket and token payout methods is that the latter may be seen as more cash-like since tokens are physically similar to coins. Association with problem gambling. It has been hypothesized in the literature that payouts in the form of tickets or tokens instead of cash can distort player perceptions of win size. 20 No evidence could be found in our review, however, to support this hypothesis. Similarly, no research could be found that addresses the potential impact that modifications to payout methods could have on problem gambling. Cheques Definition. The payout interval on an EGM refers to the delay in time between when a player wins a game and when they receive their winnings. One method of extending the payout interval is to deliver the player s winnings (when the winnings are relatively large) by cheque. If winnings are paid out to the gambler this way, they cannot be cashed in for more tokens or credits at the gaming venue, which is believed to be a helpful tool in minimizing harm. Association with problem gambling. Two studies were found that investigated the effect of cheque payments on the behaviour of EGM players. The first study involved interviews with self-identified problem gamblers (N = 16), recreational gamblers (N = 45), gaming managers (N = 60), community representatives, counsellors, and expert analysts. It looked at the impact of paying patrons with a cheque for winnings greater than $1,000. While 55% of club managers, 66% of recreational gamblers, and 72% of problem gamblers all affirmed that the effort was an effective strategy to prevent gamblers from spending their winnings, all groups claimed that many, if not all, gamblers would play down their winnings on machines or would cash out their winnings before reaching $1,000 to avoid receiving a cheque. 46 The second study looked at EGM players (N = 418) attitudes, awareness, beliefs, perceptions, challenges and behaviours related to a number of harm minimization strategies, including payment of winnings by cheque. Results revealed that 77% of EGM players thought that payment by cheque for winnings in excess of $2,000 would be an effective harm minimization strategy. Problem gamblers, however, were more likely than all others in the sample (25% versus 16%, respectively) to say that cheque payment would not be an effective harm minimization measure. Seventy-two percent of the sample thought that placing restrictions on cashing winning cheques at gaming venues would be an effective harm minimization strategy. 45 Betting Options Bet Size (Amount/Lines) Definition. Bet size is determined by a number of factors, including the denomination of the machines (the value of each credit), the number of lines one can bet on, and the number of credits played. For example, a small bet size can result from betting on one line for one credit (each credit valued at 5 cents) for a maximum bet size of 5 cents. Conversely, a large bet size can result from betting on 10 lines for 10 credits (each credit valued at 10 cents) for a maximum bet size of $1. (Note, however, that in the latter example, a gambler does not need to bet the maximum possible amount. He or she could bet on all 10 lines but choose to use fewer credits (i.e., 10 credits each valued at 5 cents, which would amount to a 50 cent bet)). In general, the higher the bet, the higher the payout when one is presented with a winning combination of symbols. Association with problem gambling. A self-report study conducted in the laboratory with problem and recreational gamblers demonstrated that problem gamblers tend to use the maximum credit function and that recreational gamblers do not. Cited in 22 Other studies have shown that compared to non-problem gamblers, problem gamblers are more likely to place bets over $1, and that when the maximum possible bet size is reduced, so is both gambling (i.e., duration, frequency, expenditure, losses), and other behaviours often associated with it (e.g., smoking and alcohol consumption). 22,23 A study conducted in Australian hotels and clubs with problem gamblers and non-problem gamblers examined the impact of certain machine modifications, including allowing for a $10 versus $1 bet size option, on player satisfaction and enjoyment, behaviour, and expenditure. While only a small percentage of the sample reported wagering with bets greater than $1, problem gamblers were three times more likely than recreational gamblers to wager with the larger amount. 14

19 Moreover, the modified machines allowing for $1 bets as compared to $10 bets were associated with players gambling for shorter periods, making fewer bets, losing less money, and smoking/drinking less. The authors of the study concluded that the reduction in maximum EGM bet size from $10 to $1 might be an effective harm minimization strategy for a small 23, 24 proportion of players. EGM-based Inducements Near-misses Definition. A near-miss on an EGM occurs when one appears to come close to, but does not actually succeed at, winning a prize. For example, in the case of a three-reel slot machine where a winning jackpot is represented by three cherry symbols, a near-miss would occur if the player received two cherries and a star. However, in reality, a near-miss is always a complete miss because it has no reward. Association with problem gambling. A potential problem with near-misses is that they could give the gambler a false sense that a win is imminent and, as a result, prompt further play. 47,48 This possibility was explored in a study conducted with a sample of non-problem gambling university students ( N = 72). In this study, the experimental group was exposed to 27% near-misses, while a second, control group, was exposed to none at all. Results revealed that those exposed to the near-misses played 33% more games than the control group. While this study was conducted with a sample of university students as opposed to problem gamblers, it does suggest that, in general, the perception of near-misses may be linked to gambling persistence in the face of monetary loss. 49 A second study, using an unspecified sample, examined three rates of near-miss presentation--0%, 33% and 67%--on gambling persistence using a computerized roulette game. A near-miss was operationally defined as an outcome with fewer than three numbers away from the number that had been chosen for the wager. Results revealed that half of the participants in the 33% condition made additional bets during the free-choice period, while none of the participants in the other conditions did. 47, 50 One interpretation of this finding is that too many near-misses decrease a player s expectation of a win, but when near-misses are intermittent, the player continues to believe that subsequent wins are likely. 51 Given that the authors of this study did not describe the problem gambling status of their sample, however, it is impossible to know whether the impact of near-misses on gambling persistence would be more or less relevant for problem gamblers. A third study, conducted with a sample of undergraduate students (N = 180) in the laboratory, examined three rates of near-miss presentation--15%, 30% and 45%--on EGM gambling persistence. Persistence was defined as the number of trials played after the near-miss condition was presented over the course of 50 plays. Results revealed that the 30% nearmiss condition led to greater persistence than did the 15% or 45% conditions. As in the previous study, the authors of this study concluded that when there are too many near-misses, participants no longer view them as indicators that a win is close at hand. 48 However, similar to the previous study, we do not know from this research whether near-misses differentially affect problem gamblers. It should also be noted that the rates of near-miss presentation used in this study do not reflect real-life gambling settings, where a near-miss may occur only 3% to 20% of the time, depending on the prize size that the symbols represent. (For example, a near-miss representing large prizes will occur far less frequently than near-misses representing smaller prizes). Due to this inconsistency, the external validity of this study is limited. Reel Display Definition. Some EGMs are programmed to prolong the presentation of a bet s final outcome and thereby increase anticipation. For example, in the case of a three-reel slot machine, each reel will stop spinning at different times so that the first reel stops spinning first, the second stops next, and the third stops last. Association with problem gambling. A study with university students (N = 28) who were occasional VLT players and not considered to be problem gamblers explored the effects of instantaneous versus sequential symbol presentation (i.e., each symbol stops individually) of bet outcomes. Results indicated that sequential presentation encouraged prolonged play, a finding theorized to result from the generation of sustained winning expectancy or anticipation. 52 No other research on this topic was found in our literature review. Prize Advertisements Definition. There are two forms of prize advertisements on EGMs. The first involves obvious prize advertisements placed on the EGM itself, such as signage indicating the size and method of a win. The second involves prize symbols placed 15

20 on the EGM s reels, which are viewed by the player as the reels spin during play. Association with problem gambling. No research was found on the relationship between EGM prize advertisements and problem gambling in our review. Game Availability Type of Games Definition. The type of game available on an EGM can vary from line games (e.g., slot-like games), to card games (e.g., poker), to keno (e.g., lottery). Association with problem gambling. No evidence was found in the literature indicating that the availability of any one type of game on an EGM is more or less problematic than another. Number of Games Definition. Some EGMs are equipped with multiple games, allowing the player more options and potentially increasing their duration of play on a given machine. Association with problem gambling. It is possible that switching between games on an EGM could increase the amount of time spent on that machine. A machine that has a number of different games may also appeal to more people, thereby potentially increasing machine traffic. 53 No research was found in our literature review, however, bearing on the relationship between EGM game number and problem gambling. Bonus Features Definition. Bonus features on EGMs, such as free games, are added to make playing on the machines more exciting, engaging, and to make players think that they are getting something for nothing. 30 In terms of the excitement factor of bonus rounds, a study was conducted looking at frequent-, infrequent- and non- gamblers (N = 63) excitement levels (as measured by autonomic arousal) during EGM play. Findings showed that in addition to wins, bonus rounds did indeed increase excitement (i.e., they elicited an increase in arousal) for all three groups. 54 Association with problem gambling. There is some evidence to suggest that bonus features, specifically free games, are potent reinforcers for regular EGM players. 55 In one study, the strategy of gamblers (N = 220) was observed during EGM play. Results showed that players often opted for a strategy of playing a maximum number of lines with low bets because this increased their chance of winning bonus rounds; however, this also resulted in more money being spent on EGM play. Unfortunately, the data presented could not speak to whether the effect of bonus rounds had a differential effect on problem gamblers. 55 Programmed Gaming Features Prize Levels and Game Outcomes Definition. The volatility of a game can be determined by the level or magnitude of prizes (e.g., small, medium, large), and the number of winning combinations required to win prizes at each level (e.g., one versus multiple). For example, in a slot machine setting, if only one combination of symbols can bring about a win at each prize level, there would consequently be only three methods of winning; however, in a situation that can increase the volatility of the game, there might be five different combinations that bring about a small prize, two different combinations that bring about a medium prize, and only one combination that bring about a large prize, resulting in eight different methods of winning. The increased variability of the number and level of prizes impacts on the amount of risk and unpredictability inherent in game play. Association with problem gambling. As the number of possible winning combinations increases for each prize level, the probability of winning increases as well, which in turn may affect gambling behaviour. However, little research could be found in our literature review on the relationship between prize levels and problem gambling. One study was identified that looked at single- versus multiple- prize games using simulated EGMs among a sample of university students (N = 80). In the single-prize game condition, participants could make a relatively safe bet or a more risky one by gambling to win either 1) 9,000 tokens with probability of.001, or 2) zero tokens. In the multiple-prize game condition, participants could make a safe bet or gamble to win 1) 9,000 tokens with probability of.0001, 2) 54 tokens with probability 0.15, or 3) zero tokens. Results indicated that the average gambling rates in the multiple-prize game were significantly higher than the average gambling rates in the single-prize game (38% versus 27%, respectively). However, this difference in gambling rates only emerged after the first 80 rounds of play. The authors concluded that a reward structure comprised of frequent medium prizes may prolong time spent gambling