Adolescent Gambling Survey Development: Findings & Reliability Information

Transcription

1 Development: Findings & Reliability Information March 15, 2010 WestEd Jeff Polik, Ph.D. & Gregory Austin, Ph.D Lampson Avenue Los Alamitos, California Phone:

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3 Preface The following report describes the development process, test retest reliability, and preliminary outcome data associated with a series of survey items assessing adolescent gambling. Focus groups and pilot surveys were initially conducted in Spring Then in Fall 2009, over 1,900 ninth and eleventh grade students from eight high schools throughout Southern California provided outcome data using the revised instrument. This survey and report was prepared by WestEd under Contract # with the Department of Alcohol and Drug Programs (DADP) Office of Problem Gambling (OPG). The project would not have been possible without the cooperation participating school principals, teachers, and students. We thank them on behalf of the OPG and WestEd. Jeff Polik and Gregory Austin, Project Directors, WestEd i P age

4 Table of Contents Preface... i Table of Contents... ii Introduction... 1 Phase 1: Pilot Study... 1 Phase 2: Gambling Outcomes & Test retest Reliability Assessment... 3 Gambling Prevalence: Activities... 4 Gambling Locations... 6 Problem Gambling... 7 Other Gambling Items... 8 Reliability Assessment... 9 Recommendation Appendix A: Reliability Tables Appendix B: Retest Survey (Gambling Items Only) Appendix C: Student Health Survey (Gambling and Other Risk Items) ii P age

5 Introduction The 2005 and 2007 Biannual California Student Surveys (CSS) provided the first preliminary data on the scope of adolescent gambling in California, but the one gambling question in 2005 CSS and the two in 2007, offered only a glimpse into this behavior which raised important questions about assessment. 1 The resulting gambling prevalence estimates were lower than those commonly found in similar surveys of adolescents conducted in North America. Many of these other surveys asked more detailed questions. This suggested the need for a more thorough investigation of youth gambling aimed at identifying the best ways to get accurate data while minimizing the intrusion into classroom instruction time. The present study describes the development of a series of gambling related items providing a broader view of the scope and nature of adolescent gambling in California. These items encompass how frequently youth engage in various forms of gambling, where they do it, and problems that some experience associated with gambling. This report includes a description of the item development process, test retest reliability information, as well as preliminary outcome data. Data from nearly two thousand participants estimate that 2 out of 3 high school students have engaged in some form of gambling in the past year. Based on psychometric analyses, we recommend the frequency by gambling activity items as part of a broader survey of other risk behaviors to monitor and guide prevention and intervention efforts. Phase 1: Pilot Study The initial phase of the study involved piloting a preliminary set of gambling questions in two classrooms (one 9 th and one 11 th grade) at four high schools in Southern California. Item selection was borne out of discussions with the Office of Problem Gambling (OPG) and the study s expert advisory committee (Dr. Timothy Fong & Dr. Durand Jacobs). The study focused on these two grade levels so that some students in the sample were young enough to test out the developmental appropriateness of gambling questions, and others were old enough to have experienced gambling problems. Participating schools and classrooms were selected on a volunteer basis; however, an effort was made to recruit schools representing a cross section of California s adolescent population. In the Spring 2009, pilot surveys were administered in the participating classrooms at each school. Immediately following the surveys, focus groups were conducted with 8 10 students 1 In 2005 the item read, During the past 12 months, how many times have you used money to bet or gamble? In 2007 two items were included, During the past 12 months, have you gambled (bet) for money or valuables in any of the following ways? (Mark All That Apply): I have not gambled in the past 12 months, card games, personal skill, games, betting on sports teams, lottery, bingo, dice games, gambling machines, horse racing, online gambling, and gambling in some other way. Following this question, respondents were asked, During the past 12 months, how many times have you gambled (bet) for money or valuables in any way? Response options included: I have not gambled (bet) in the past 12 months, 1 time, 2 or 3 times, 4 to 9 times, 10 or more times. 1 P age

6 from each class to discuss the items and any problems they had with item wording or understanding the meaning of the questions. Highlights from the focus group discussions are: Betting versus gambling: Some students, younger ones in particular, made a distinction between betting and gambling. They viewed the word gambling as more negative or sinister than betting, which conversely was often perceived as casual. From the focus group discussions it became clear that the words betting and gambling could not be used interchangeably and that they would need to be paired throughout the final survey (i.e., betting/gambling). Casual Betting: Similarly, students often viewed casual betting between friends or family as not really gambling. For example, a $10 bet between friends on a football game was not considered as gambling by many focus group participants. As a result, the phrase even casually was added to questions about gambling frequency on the final survey (see Table 2). Personal Challenges: One of the activities students indicated they commonly bet on is in the form of personal challenges, like a dare. This was not covered by the pilot survey, but added to the frequency/activity section of the final survey instrument. Based on analysis of the initial pilot survey data, and insights derived from the student focus groups, a revised instrument was developed. This survey was then subjected to another round of piloting, more focus groups, and final input from the advisory committee. It was decided to collect gambling frequency information for each type of gambling activity, rather than overall as was done on the previous California Student Surveys. A mark all that apply format was also chosen for the problem gambling items based on pilot information. The resulting 16 items (Appendix B) were used for the collection of preliminary outcome data and the test retest reliability assessment. 2 P age

7 Phase 2: Gambling Outcomes & Test-retest Reliability Assessment In the Fall 2009, responses to the final set of gambling items were collected from 1,934 students at 8 high schools throughout Southern California (See Table 1). The data was collected using a thirty nine item Student Health Survey (Appendix C), which includes a mix of risk items (i.e., alcohol, drug, and tobacco use), as well as the 16 gambling related items. The inclusion of other risk items not only allowed for the assessment of co occurring behaviors (i.e., gambling and drug use), but also more closely resembled the context in which the gambling items would most likely be used in the future (e.g., included in CSS articles). The addition of the risk items also minimizes the likelihood of the potential threat of a demand on respondents to indicate gambling in the last 12 months if they had not. Table 1. Demographic variables for study participants Demographic Variable Num (n=1934) % Gender Male % Female % Age 14 years old or younger % 15 years old % 16 years old % 17 years old or older % Grade 9th grade % 10th grade % 11th grade % 12th grade % Ethnicity* American Indian or Alaska Native 5 0.3% Native Hawaiian or Pacific Islander % Asian or Asian American % Black or African American % Hispanic or Latino/Latina % White (Caucasian/non Hispanic) % Multi Ethnic % Other % Missing % *Categories are mutually exclusive; multi ethnic was computed for respondents who selected more than one ethnic group. 3 P age

8 Gambling Prevalence: Activities Students were asked, During the past 12 months, how often have you bet/gambled, even casually, for money or valuables in the following ways? This question was followed by a list of eleven gambling activities and a catchall, bet/gambled in some other way. Response options for each activity included: Not at all, Less than once a month, 1 to 3 times a month, and Once a week or more. This format for assessing gambling prevalence offers several advantages over the previous, 12 month any gambling item. First, it allows for the assessment of which gambling activities students are most commonly engaging in, as well as the intensity of participation. For example, activities with a large percentage of students indicating participation once a week or more could be targeted for media awareness campaign. Second, student s overall intensity or potential for problem gambling can be estimated by summing frequency across the activities. Table 2 describes the number and percentage of respondents by activity item. Table 2. Percentage and number of responses to: "During the past 12 months, how often have bet/gambled, even casually, for money or valuables in the following ways?" by gambling activity (n=1934) Gambling Activity Not at all Less than once a month 1 to 3 times a month Once a week or more 1. Card games (such as poker, blackjack)? 63.6% (1226) 21.1% (406) 9.2% (177) 6.1% (118) 2. Personal skill games (such as pool, darts, coin tossing, video games)? 56.2% (1084) 18.9% (364) 11.6% (223) 13.4% (259) 3. Betting on sports? 65.6% (1263) 17.7% (340) 9.3% (178) 7.4% (143) 4. Lottery (such as scratch cards, numbers, lotto)? 82.1% (1586) 12.2% (235) 3.3% (64) 2.5% (48) 5. Bingo? 85.4% (1648) 10.5% (203) 2.0% (38) 2.1% (40) 6. Dice games? 85.2% (1644) 8.9% (171) 3.7% (71) 2.2% (43) 7. Gambling machines? 95.2% (1839) 2.9% (56) 0.6% (12) 1.2% (24) 8. Horse racing? 94.6% (1827) 3.6% (69) 0.8% (16) 1.0% (20) 9. Online (internet) gambling? 91.1% (1758) 4.0% (78) 2.3% (45) 2.5% (49) 10. Dominoes? 86.0% (1660) 7.9% (152) 3.8% (74) 2.3% (44) 11. Personal challenges (like a dare)? 12. Bet/gambled in some other way? 57.4% (1106) 23.2% (447) 11.8% (227) 7.6% (147) 70.1% (1350) 16.8% (324) 7.6% (147) 5.5% (106) 4 P age

9 Results for the activities items show that the most common gambling activities are, in descending order, Personal Skill Games (44%), Personal Challenges (43%), Card Games (36%), and betting on Sports (34%). Least popular were Gambling Machines (5%) and Horse Racing (5%), followed by Online/Internet gambling (9%). The lower participation in these activities is not surprising given the barrier to accessibility student age presents. The overall prevalence for gambling in the last 12 months was calculated by counting any respondent who marked anything other than not at all for at least one of the activities listed and was found to be 69%. This method of calculating prevalence may over estimate the percentage of adolescents who have gambled in the past year because it takes advantage of errors in responding (e.g., marking the wrong bubble). This issue will be addressed further in the discussion section. 5 P age

10 Gambling Locations To get a sense of where adolescents are gambling, survey respondents were presented with the statement, If you bet/gamble, please mark all of the places you make bets (Mark All that Apply). This statement was followed by, I do not bet/gamble, ten specific locations, and an other location option. Table 3 depicts the number and percentage of respondents by location for students who indicated that they gambled at one or more locations (i.e., students who are gamblers, n=980). Table 3. Number and percentage of responses to: "If you bet/gamble, please mark all of the places you make bets"* Location Num (n=980) % Home % Friend's house % School % Stores (lottery games) % Internet/online % Casino % Card club % Sporting event % Horse racing track % Neighborhood (streets, park, etc.) % Other % * Excludes respondents who marked "I don't not bet/gamble" or left the entire item blank. Results indicate that the most common places students who gamble report gambling are at Home (74%), at Friends homes (61%), and at School (41%). The least common locations to gamble are again where age is most likely to be a barrier: Casino and Card club (3%), Horse racing track (6%), and Stores/lottery (8%). The percentage for Stores/lottery may be an underestimation because questions raised by some students during the survey administrations suggest that they considered where they scratched their lottery tickets rather than where they purchased them. 6 P age

11 Problem Gambling As noted earlier, potential problem gambling could be estimated by the intensity or frequency of participation a respondent indicates across one or more gambling activities. However, a more direct measure of problem gambling was included on the survey in the form of a series of statements for which respondents were asked to, Mark all of the statements that are TRUE about you betting/gambling over the past 12 months (Mark All that Apply). Included were twelve statements that research indicates are related to problem gambling. Additionally, students could indicate, I did not bet in the past 12 months or I bet in the past 12 months, but none of the previous statements are true for me. Table 4 includes the number and percentage of responses to each statement among those students who marked at least one statement other than I did not bet in the last 12 months (n=843). Table 4. Number and percentage of responses to symptoms of "at risk" gambling items: "Mark all of the statements that are TRUE about your betting/gambling over the last 12 months"* Problem Gambling Statement Num (n=843) % I borrowed or asked for money that I used for betting % My betting caused an argument with someone important to % me. My betting interfered with my regular activities % I spent more time betting than I meant to % I bet more money (or valuables) than I meant to % I felt the need to bet more and more money or valuables % I lied to someone important to me about how much I bet % I lost track of time while betting % I felt sad or depressed for two weeks or longer because of betting and losing % I tried to win back losses after betting and losing % I bet more after winning because I felt I was "on a roll" % (would keep winning). I bet regularly, once a week or more % * Excludes respondents who: (1) marked "I did not bet in the past 12 months" (2) Did not respond to the item. Marking any one of the problem gambling statements alone is not necessarily a reason for concern; however, multiple marks suggest a potential gambling problem. Of the 843 students who responded to this item series and indicated gambling in the last 12 months, 57% marked none of the problem gambling statements, 22% marked only one, 8% marked two, and 13% marked 3 or more. 7 P age

12 Other Gambling Items Two other stand alone items were assessed: (1) Peer gambling environment, How many people do you personally know (friends or adults) who bet/gamble regularly (once a week or more)? and (2) Financial level of involvement, In the past 12 months, what is the largest amount of money (or valuables) you placed in a single bet/wager?. Response frequencies to these two items appear in Tables 5 and Table 6, respectively. For the financial level of involvement item, only the responses of those who indicated gambling are presented. Responses at the higher end of the options for these questions can imply a potential for problem gambling especially when viewed along with the other problem gambling items. Table 5. Number and percentage of responses to: "How many people do you personally know (friends or adults) who bet/gamble regularly (once a week or more)" Number of People Num (n=1916) % None % 1 or % 3 or % 5 or more % Table 6. Number and percentage of gamblers* responses to: "In the past 12 months, what is the largest amount of money (or valuables) you placed in a single bet/wager?" Amount Wagered Num (n=975) % Less than $ % $10 to $ % $26 to $ % $51 to $ % $101 to $ % More than $ % *Excludes respondents who indicated they had not bet/gambled in the past 12 months or left the item blank. 8 P age

13 Reliability Assessment In order to assess the temporal stability of the gambling items over time, a test retest reliability study was conducted in four of the eight high schools. Approximately two weeks after completing the initial Student Health Survey, participating students at these four schools completed a brief retest survey containing only the gambling items (Appendix 2). The demographic and non gambling risk items were removed from the retest survey to reduce survey administration time and minimize the intrusion on classroom instruction. A total of 949 students provided matched test and retest data for reliability assessment. A protocol was used to maintain the anonymity of the subjects yet allow for the matching of time one and time two responses. Although several of the items included multiple response options, for purposes of reliability estimation, the options were collapsed (dichotomized) for analysis. Reporting of gambling is often done in a none versus some format and to be able to assess the relative stability of the items this method was selected. As a measure of consistency, prevalence rates for each item were calculated for both survey administrations. These rates were considered different and, therefore, inconsistent if the 95% confidence intervals for each did not overlap. Two sets of reliability estimates were also calculated for each gambling item. To estimate consensus or the degree of agreement across administrations, percentages of exact agreement between the two survey occasions were calculated, as were Cohen s kappa statistics. Kappa is a more conservative index of agreement in that a correction is made for the amount of agreement that could be expected by chance alone. The results of the reliability analyses are described in Tables A1 thru A4 in Appendix A. The temporal stability of the prevalence rates was stable across time for all of the gambling items. None of the 95% confidence intervals (CI) for a variable at Time 1 failed to overlap with the CI for that variable at Time 2. This does not mean the prevalence rates are the same across time, but it cannot be concluded statistically that they differ. Kappa statistics ranged from.21 to.67, with a mean of.46. The majority (two thirds) of the kappas fall between.4 and.6 and are considered moderate, in consensus. The percentage agreement statistics are considerably higher, but do not account for agreement that occurs by chance, which becomes increasingly problematic as response options decrease. Because scores were collapsed into two categories, none and some, the more conservative estimate of consensus is the kappa statistic. There are two areas of concern based on the reliability evidence. First, within the gambling location items (Table A2) the Casino and Card Club items had lower kappas (.32 and.24, respectively) than the other locations suggesting a lack of clarity in distinguishing between the two among some participants. These two should probably be combined into one Casino/Card Club item in the future. The second area of concern in terms of temporal 9 P age

14 stability is the Problem Gambling group (Table A3). The kappa statistics for this group are considerably lower than for the other gambling items, particularly for items that are open to multiple interpretations (i.e., I felt the need to bet more and more money or valuables or My betting interfered with my regular activities ). The unreliability of these items also may be in part to how they were measured. The Mark all that Apply format used with the problem gambling items does save precious space and time on a survey, but has a price in terms of reliability. A format where each question is asked individually would be likely to lead to more consistent results over time, but would need to be assessed before these items could be recommended as a diagnostic tool. For purposes of prevalence estimation, however, they provided adequately consistent results (Table A3). It should also be noted that combining items into scales, for like items like the Activities group and for Problem Gambling statements, results in increased consistency between Time 1 and Time 2 measurements (r = 0.7 and 0.38, respectively). Overall, the reliability evidence is substantial enough to warrant the use of the majority of the items with the minimal revisions noted. The developed module has utility for population or prevalence estimation, but would need more development to be appropriate for diagnostic use. Recommendation Given the reluctance of schools to give up classroom instruction time to participate in surveys, it is important to determine what mix of questions would provide the most information in the shortest amount of time, and what would be the best survey method to use. Based on the findings from this study, the 12 gambling frequency by activity questions would be the best way to monitor how California s youth are doing with regard to gambling over time. These items allow for the assessment of trends in participation rates for various gambling activities, as well as overall prevalence. Problem gambling can also be estimated based on the percentage indicating once a week or more for any activity. Including these items in a statewide survey of risk behaviors such as the California Student Survey (CSS) or the California Healthy Kids Survey (CHKS) is a cost effective way to keep a finger on the pulse of youth gambling across the State. The gambling location items and the problem gambling items could also be used as an add on supplementary module to the CHKS in schools or districts located near casinos, or those that are otherwise interested in more gamblingrelated information about their students. Should state funds become available to support gambling prevention activities in schools, acceptance of these funds could be tied to administering this module, a common practice. Statewide data on the 12 gambling frequency by activity items for 7 th, 9 th, and 11 th grade students is currently being collected as part of the CSS and will be available in the Summer of P age

15 Appendix A: Reliability Tables Table A1. Prevalence over time and consensus estimates for responses to gambling activity items: "During the past 12 months, how often have bet/gambled, even casually, for money or valuables in the following ways?"* Activity Time 1 Time 2 Agreement Kappa Over Time 1. Card games (such as poker, blackjack)? 37.7% 39.5% 78.9% Personal skill games (such as pool, darts, 46.3% 46.5% 76.1% 0.52 coin tossing, video games)? 3. Betting on sports? 35.1% 33.9% 82.5% Lottery (such as scratch cards, numbers, 21.8% 18.5% 82.9% 0.47 lotto)? 5. Bingo? 17.2% 16.2% 84.4% Dice games? 16.1% 16.7% 85.4% Gambling machines? 4.5% 5.5% 95.3% Horse racing? 4.6% 4.3% 95.9% Online (internet) gambling? 9.9% 10.3% 89.0% Dominoes? 16.8% 15.7% 87.3% Personal challenges (like a dare)? 47.0% 42.3% 78.9% Bet/gambled in some other way? 33.1% 29.9% 79.2% 0.52 * Surveyed response options included: "Not at all", " Less than once a month", "1 to 3 times a month", and "Once a week or more", dichotomized to "None" & "Some". 11 P age

16 Table A2. Prevalence over time and consensus estimates for responses to gambling location items: "If you bet/gamble, please mark all of the places you make bets" (Mark all that apply)* Location Time 1 Time 2 Agreement Kappa Over Time I do not bet/gamble 46.9% 47.7% 83.8% 0.67 Home 41.1% 40.6% 80.5% 0.6 Friend's house 33.9% 32.3% 81.8% 0.59 School 24.6% 25.5% 84.1% 0.58 Stores (lottery games) 4.7% 5.0% 95.4% 0.5 Internet/online 6.5% 5.6% 93.6% 0.4 Casino 3.1% 2.0% 96.6% 0.32 Card club 1.8% 2.3% 96.9% 0.24 Sporting event 17.0% 13.4% 89.3% 0.58 Horse racing track 2.4% 2.0% 98.5% 0.66 Neighborhood (streets, park, etc.) 19.5% 18.7% 87.8% 0.6 Other 15.9% 15.4% 86.0% 0.47 * Response options include: marked or unmarked. 12 P age

17 Table A3. Prevalence over time and consensus estimates for responses to "at risk" gambling items: "Mark all of the statements that are TRUE about your betting/gambling over the last 12 months"* Statement Time 1 Time 2 Agreement Kappa Over Time I did not bet in the past 12 months 53.0% 56.6% 80.8% 0.61 I borrowed or asked for money that I used for betting. 6.1% 5.2% 92.0% 0.25 My betting caused an argument with someone important to me. 4.0% 3.4% 95.2% 0.32 My betting interfered with my regular activities. 2.1% 2.4% 96.5% 0.21 I spent more time betting than I meant to. 1.8% 2.5% 97.2% 0.33 I bet more money (or valuables) than I meant to. 4.0% 3.6% 95.8% 0.42 I felt the need to bet more and more money or valuables. 2.0% 1.8% 97.1% 0.21 I lied to someone important to me about how much I bet. 3.1% 2.1% 96.1% 0.23 I lost track of time while betting. 3.3% 3.9% 94.9% 0.27 I felt sad or depressed for two weeks or longer because of betting and losing. 0.6% 0.9% 98.8% 0.26 I tried to win back losses after betting and losing. 6.4% 6.4% 92.8% 0.4 I bet more after winning because I felt I was "on a roll" (would keep winning). 6.6% 5.4% 94.3% 0.5 I bet regularly, once a week or more. 4.8% 5.7% 94.9% 0.49 I bet in the past 12 months, but none of the statements above are true for me. 26.7% 25.8% 80.8% 0.5 * Response options include: marked or unmarked. 13 P age

18 Table A4. Prevalence over time and consensus estimates for responses to "other" gambling questions. Question Time 1 Time 2 Agreement Over Time Kappa How many people do you personally know (friends or adults) who bet/gamble regularly (once a week or more)?* In the past 12 months, what is the largest amount of money (or valuables) you placed in a single bet/wager?** 64.3% 67.3% 75.8% % 48.0% 84.2% 0.68 * Surveyed response options: "None", "1 or 2", "3 or 4", and "5 or more", dichotomized to "None" & "Some". ** Surveyed response options: "I have not bet/gambled in the past 12 months", "Less than $10", "$10 to $25", "$26 to $50", "$51 to $100", "$101 to $200", and "More than $200", dichotomized: "None" & "Some". 14 P age

19 Appendix B: Retest Survey (Gambling Items Only) Gambling Retest Survey 2009 Grades 9 and 11 This is a survey about gambling-related behaviors, experiences and attitudes. It includes questions from a survey your recently took about the use of alcohol, tobacco, and other drugs, as well as gambling. You are being asked the gambling questions again to find out which are good at getting consistent answers from people. You will be able to answer whether or not you have done or experienced any of these things. You do not have to answer these questions, but your answers will be very helpful in determining which questions are the best to find about gambling behaviors and attitudes. Please ONLY WRITE YOUR NAME ON THE ASSENT FORM, not the answer sheet. Do not identify yourself in any other way. Your answers will be kept confidential; no one at your school will know how you answered unless you tell them. Please mark all of your answers on the answer sheet. Do not write on the questionnaire. Mark only one answer unless told to "Mark All That Apply." Thank you for doing this survey! 4665 LAMPSON AVENUE LOS ALAMITOS, CA (562) P age

20 During the past 12 months, how often have you bet/gambled, even casually, for money or valuables in the following ways? Less than 1 to 3 Once a once a times a week or Not at all month month more 1. Card games (such as poker, blackjack)? A B C D 2. Personal skill games (such as pool, darts, coin tossing, video games)? A B C D 3. Betting on sports? A B C D 4. Lottery (such as scratch cards, numbers, lotto)? A B C D 5. Bingo? A B C D 6. Dice games? A B C D 7. Gambling machines? A B C D 8. Horse racing? A B C D 9. Online (internet) gambling? A B C D 10. Dominoes? A B C D 11. Personal challenges (like a dare)? A B C D 12. Bet/gambled in some other way? A B C D 13. If you bet/gamble, please mark all of the places you make bets. (Mark All that Apply) A) I do not bet/gamble B) Home C) Friend s house D) School E) Stores (lottery games) F) Internet/online G) Casino H) Card Club I) Sporting event J) Horse racing track K) Neighborhood (streets, park, etc.) L) Other TURN PAGE OVER 16 P age

21 14. Mark all of the statements that are TRUE about your betting/gambling over the past 12 months.(mark All that Apply) A) I did not bet in the past 12 months. B) I borrowed or asked for money that I used for betting. C) My betting caused an argument with someone important to me. D) My betting interfered with my regular activities. E) I spent more time betting than I meant to. F) I bet more money (or valuables) than I meant to. G) I felt the need to bet more and more money or valuables. H) I lied to someone important to me about how much I bet. I) I lost track of time while betting. J) I felt sad or depressed for two weeks or longer because of betting and losing. K) I tried to win back losses after betting and losing. L) I bet more after winning because I felt I was on a roll (would keep winning). M) I bet regularly, once a week or more. N) I bet in the past 12 months, but none of the statements above are true for me. 15. How many people do you personally know (friends or adults) who bet/gamble regularly (once a week or more)? A) None B) 1 or 2 C) 3 or 4 D) 5 or more 16. In the past 12 months, what is the largest amount of money (or valuables) you placed in a single bet/wager? A) I have not bet/gambled in the past 12 months B) Less than $10 C) $10 to $25 D) $26 to $50 E) $51 to $100 F) $101 to $200 G) More than $200 Thank You For Completing This Survey! 17 P age

22 Appendix C: Student Health Survey (Gambling and Other Risk Items) Student Health Survey 2009 Grades 9 and 11 This is a survey about health-related behaviors, experiences and attitudes. It includes questions about use of alcohol, tobacco, and other drugs; gambling; and bullying and violence. You will be able to answer whether or not you have done or experienced any of these things. You do not have to answer these questions, but your answers will be very helpful in potentially improving health services. Please ONLY WRITE YOUR NAME ON THE ASSENT FORM, not the answer sheet. Do not identify yourself in any other way. Your answers will be kept confidential; no one at your school will know how you answered unless you tell them. Please mark all of your answers on the answer sheet. Do not write on the questionnaire. Mark only one answer unless told to "Mark All That Apply." This survey asks about things you may have done during different periods of time, such as during your lifetime (did you ever do something), or the past 12 months, or 30 days. Each question provides different information. Please pay careful attention to these time periods. Thank you for completing this survey! 4665 LAMPSON AVENUE LOS ALAMITOS, CA (562) P age

23 First, we would like some background information about you. 1. How old are you? A) 13 years old or younger B) 14 years old C) 15 years old D) 16 years old E) 17 years old F) 18 years old or older 2. What is your sex? A) Male B) Female 3. In what grade are you? A) 9th grade B) 10th grade C) 11th grade D) 12th grade 4. How do you describe yourself? (Mark All That Apply) A) American Indian or Alaska Native B) Native Hawaiian or Pacific Islander C) Asian or Asian American D) Black or African American (non-hispanic) E) Hispanic or Latino/Latina F) White (Caucasian/non-Hispanic) G) Other 19 P age

24 The next questions are about the use of alcohol, tobacco, marijuana, and other drugs Keep the following definitions in mind. One drink of ALCOHOL, or alcoholic drink (beverage), means one regular size can/bottle of beer or wine cooler, one glass of wine, one mixed drink, or one shot glass of liquor. Questions about alcohol do not include drinking a few sips of wine for religious purposes. DRUG means any substance, including pills and medications, used to get "high" (loaded, stoned, or wasted) other than alcohol or tobacco. During the past 12 months, how often did you use Less than 1 to 3 Once a once a times a week or Not at all month month more 5. cigarettes? A B C D 6. smokeless tobacco (chew or snuff)? A B C D 7. at least one drink of alcohol? A B C D 8. five or more drinks of alcohol in a row, that is, within a couple of hours? A B C D 9. marijuana (pot, weed, grass, hash)? A B C D 10. inhalants (things you sniff, huff, or breathe to get high)? A B C D 11. cocaine (any form coke, crack, rock, base, snort)? A B C D 12. methamphetamine or any amphetamines (meth, speed, crystal, crank)? A B C D 13. ecstasy, LSD or other psychedelics? A B C D 14. any other illegal drug or pill to get high? A B C D 15. two or more drugs at the same time (for example, alcohol with marijuana, or ecstasy with mushrooms)? A B C D 16. How do you like to drink alcohol? A) I don t drink alcohol B) Just a sip or two C) Enough to feel it a little D) Enough to feel it moderately E) Until I feel it a lot or get really drunk 20 P age

25 17. If you use marijuana or other drugs, how high (stoned, faded, wasted, trashed) do you usually like to get? A) I don t use drugs B) Not high at all C) A little high D) Moderately high E) Really high or wasted 18. In your life, how many times have you driven a car when you had been drinking alcohol or been in a car driven by a friend when he or she had been drinking? A) Never B) 1 time C) 2 times D) 3 to 6 times E) 7 or more times The next questions are about betting/gambling. During the past 12 months, how often have you bet/gambled, even casually, for money or valuables in the following ways? Less than 1 to 3 Once a once a times a week or Not at all month month more 19. Card games (such as poker, blackjack)? A B C D 20. Personal skill games (such as pool, darts, coin tossing, video games)? A B C D 21. Betting on sports? A B C D 22. Lottery (such as scratch cards, numbers, lotto)? A B C D 23. Bingo? A B C D 24. Dice games? A B C D 25. Gambling machines? A B C D 26. Horse racing? A B C D 27. Online (internet) gambling? A B C D 28. Dominoes? A B C D 29 Personal challenges (like a dare)? A B C D 30. Bet/gambled in some other way? A B C D 21 P age

26 31. How many people do you personally know (friends or adults) who bet/gamble regularly (once a week or more)? A) None B) 1 or 2 C) 3 or 4 D) 5 or more 32. If you bet/gamble, please mark all of the places you make bets. (Mark All that Apply) A) I do not bet/gamble B) Home C) Friend s house D) School E) Stores (lottery games) F) Internet/online G) Casino H) Card Club I) Sporting event J) Horse racing track K) Neighborhood (streets, park, etc.) L) Other 33. In the past 12 months, what is the largest amount of money (or valuables) you placed in a single bet/wager? A) I have not bet/gambled in the past 12 months B) Less than $10 C) $10 to $25 D) $26 to $50 E) $51 to $100 F) $101 to $200 G) More than $ P age

27 34. Mark all of the statements that are TRUE about your betting/gambling over the past 12 months. (Mark All that Apply) A) I did not bet in the past 12 months. B) I borrowed or asked for money that I used for betting. C) My betting caused an argument with someone important to me. D) My betting interfered with my regular activities. E) I spent more time betting than I meant to. F) I bet more money (or valuables) than I meant to. G) I felt the need to bet more and more money or valuables. H) I lied to someone important to me about how much I bet. I) I lost track of time while betting. J) I felt sad or depressed for two weeks or longer because of betting and losing. K) I tried to win back losses after betting and losing. L) I bet more after winning because I felt I was on a roll (would keep winning). M) I bet regularly, once a week or more. N) I bet in the past 12 months, but none of the statements above are true for me. The next questions are about violence, safety, harassment, and bullying. During the past 12 months, how many times on school property have you to 3 4 or more Happened on School Property times time times times 35. been pushed, shoved, slapped, hit, or kicked by someone who wasn t just kidding around? A B C D 36. been threatened or injured with a weapon (gun, knife, club)? A B C D 37. seen someone carrying a gun, knife, or other weapon? A B C D 38. had your property stolen or deliberately damaged, such as your car, clothing, or books? A B C D 39. How many questions in this survey did you answer honestly? A) All of them B) Most of them C) Only some of them D) Hardly any Thank You For Completing This Survey! 23 P age