Building Youth Resilience against Problem Gambling: A Health Promotion Framework

Transcription

1 Building Youth Resilience against Problem Gambling: A Health Promotion Framework 1

2 Acknowledgements Building youth resilience against problem gambling: a health promotion framework is funded by the Victorian Responsible Gambling Foundation (VRGF). This report was developed and managed by Central Victorian Primary Care Partnership (CVPCP) on behalf of the CVPCP Problem Gambling Working Group. This report has been produced by: Emma Shannon (Project Officer) and Dr Jan Savage (Executive officer) of CVPCP. We would like to acknowledge the assistance and time provided by the CVPCP Problem Gambling Working Group, and the youth service providers and young people who helped to provide the data included in this report. This document is also available in an accessible format on the internet at Copyright State of Victoria This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act For further information about this publication contact: Ms Emma Shannon Project Officer Central Victorian Primary Care Partnership P.O. Box 687, Castlemaine, 3450 Tel: emmashannon@centralvicpcp.com.au Citation: Shannon, E & Savage J. (2013). Building youth resilience against problem gambling: A health promotion framework. Central Victorian Primary Care Partnership. Castlemaine. CVPCP Building Youth Resilience against Problem Gambling 2

3 Contents Acknowledgements... 2 EXECUTIVE SUMMARY... 5 INTRODUCTION... 6 Project Aims... 6 Project Objectives... 6 METHODS... 7 Youth Survey... 7 Recruitment of participants... 7 Data Collection... 8 Data Analysis... 8 Youth Service Providers Survey... 8 Recruitment of participants... 8 Data Collection... 8 Data Analysis... 8 Youth Service Providers Focus Groups... 9 Recruitment of participants... 9 Data Collection... 9 Data Analysis... 9 RESULTS A) Youth Survey Survey participants Gambling behaviours of young people Characteristics and gambling behaviours of at-risk gamblers vs not-at-risk gamblers Internet gambler characteristics Influences for gambling Risky behaviours Health and wellbeing Seeking help B) Youth Service Providers Survey Impact of problem gambling on youth service providers Referral process Screening/Assessment Treatment/Prevention/Early Intervention CVPCP Building Youth Resilience against Problem Gambling 3

4 C) Youth Service Providers Focus Groups Screening Referrals Awareness Raising Capacity Building Other discussion points School conversations DISCUSSION Limitations of the Study A) Youth Feedback Gambler Characteristics and Behaviours Resilience B) Youth Service Providers Feedback Health Promotion Framework CONCLUSION References CVPCP Building Youth Resilience against Problem Gambling 4

5 EXECUTIVE SUMMARY The aim of this report is to provide an overview of the status of youth gambling within the Central Victorian Primary Care Partnership (CVPCP) catchment 1 ; to determine the current needs of youth service providers; and to identify prevention and early intervention strategies aimed at building the resilience of youth in the CVPCP catchment that will reduce the risks of youth problem gambling. Problem gambling is characterised by difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community (Neal, Delfabbro, & O Neil, 2005, pp.125). The prevalence of problem gambling amongst young people has been found to be higher than that in the adult population, with both international and local research finding that 5-7% of young people are problem gamblers and a further 10-14% are at risk or have the potential to become problem gamblers (Purdie et al, 2011; Valentine, 2008; Jackson, 2006). The current research has focused on online gambling and has found that young people in the CVPCP catchment are utilising this form of gambling. The growth of online gambling opportunities is of concern in rural and regional areas as it has the potential to attract new problem gamblers where previously access was limited. This is reflected in the current study as young people reported engaging in internet gambling because of its convenience and ready access. Internet gamblers in this study also tended to exhibit some of the characteristics associated with at risk or problem gamblers, in that they participated in a larger number of gambling activities, and more often reported taking part in other risky behaviours compared with non-internet gamblers. Internet gamblers in this study were also more likely to be classified as being at-risk than non-internet gamblers. Overall this place based youth survey supports much of the prior research regarding youth gambling, in particular online gambling. Our findings point to a number of young people at risk of developing problems with gambling in our catchment. The impact of this on the health and wellbeing of our young residents will most likely increase as internet gambling becomes more widespread. The current report has gone some way to confirming that resilience has an impact on outcomes, and that prevention of gambling problems must incorporate risk prevention and promotion of protective factors in order to build resilience. The feedback sought from youth service providers has identified strategies that will contribute to the prevention and early intervention of gambling related problems. Increased awareness of youth gambling and capacity to identify risks are recommended to be addressed across the youth service system including in schools. Improving partnerships between agencies in order to build the reslience and social connectedness of young people has been recommended. This focus on collaborative work to reduce the risks of problem gambling will allow for problem gambling prevention to be addressed in conjunction with the prevention of other harmful behaviours for more effective and widespread results. Recommendations to guide health promotion efforts aimed at building youth resilience against problem gambling have been summarised in a one page health promotion framework document. This document outlines the target populations, settings, overarching principles, protective and risk factors, and local strategies that will help to build resilience against problem gambling in youth living in the CVPCP catchment. 1 Includes the Local Government Areas of Central Goldfields, Macedon Ranges and Mount Alexander CVPCP Building Youth Resilience against Problem Gambling 5

6 INTRODUCTION The Central Victorian PCP (CVPCP) Problem Gambling Working Group (PGWG) was convened to define and prioritise the problems of gambling in the CVPCP catchment (which covers three local government areas: Central Goldfields Shire, Macedon Ranges Shire and Mount Alexander Shire) and determine a response under the Department of Justice Problem Gambling guidelines. Problem gambling has been identified as a priority for our catchment and more broadly within the Loddon Mallee PCP region. The PGWG identified the development of problem gambling in young people as a priority concern requiring further investigation and clarification of issues. A 'rapid review' of the literature was performed to define our target population and effective interventions. This review found that the prevalence of problem gambling amongst young people is particularly high in the year old age group. The literature review also confirmed that the recent growth of online gambling opportunities is of concern for youth problem gambling service providers. Very little evidence was found to support any particular youth focused prevention and early intervention strategies. The link between gambling and gaming is also a strong one, in fact gaming has been described as a nonfinancial form of gambling, playing for points instead of money (Griffiths, 2005). This is an area that has not been specifically studied in this report; however as the project has progressed the issue of gaming amongst young people has been raised numerous times. Any outcomes or strategies recommended in this document may be able to be adapted to incorporate both gaming and gambling issues. This report describes the methods and findings of the CVPCP Problem Gambling Project which is a regional study focussing on year olds and their gambling. Of particular interest were online gambling and the protective or preventative role of building the resilience and social connectedness of young people. Project Aims To increase knowledge about youth at risk of problem gambling, understanding of youth service provider knowledge and prevention and early intervention strategies to manage this issue, particularly amongst year old people in the CVPCP catchment. To increase awareness of problem gambling amongst young people aged years old in the CVPCP catchment. Project Objectives To estimate: Gambling within the target population. Social connectedness and resilience amongst the target population. The awareness of youth problem gambling amongst youth service providers in the CVPCP catchment. The patterns of online gambling amongst the target population. To describe: The influences and correlates of problem gambling amongst the target population. The attitudes towards gambling of the target population. To identify: Successful strategies to engage youth, including those at risk or exhibiting harmful behaviours, within the target population. To develop: A Health Promotion framework that will guide the implementation of strategies aiming to build resilience against problem gambling in youth. CVPCP Building Youth Resilience against Problem Gambling 6

7 METHODS Ethics approval was obtained from the Department of Justice Human Research and Ethics Committee before carrying out this research. A review of the literature (see appendix 1) informed the development of a survey to collect information from young people aged years old about their gambling habits, influences and health and wellbeing. A survey was also developed to gather information from youth service providers about the impact of problem gambling, current service delivery models in relation to identification and referral, and the skills, knowledge and resource needs of agencies. Further to and informed by this survey, three focus groups were held with youth service providers (one in each shire) to explore in more depth some of the issues raised by the survey. The following sections will provide more information about the methodologies used to develop and disseminate the tools, and collect and analyse responses. Youth Survey The Youth survey (see appendix 2) was developed by the project officer in consultation with CVPCP staff and the CVPCP Problem Gambling Working Group. The aim of the survey was to gather information from young people living in the CVPCP catchment about their gambling behaviours including use of internet gambling, motivations for gambling, influences from others, risky behaviours, health and wellbeing and help seeking behaviours and attitudes. Recruitment of participants Youth participants were recruited using various methods in order to maximise participation rate: 1. Social media was used to recruit participants. An advertisement was placed on Facebook. This advertisement was placed on various pre-existing local and regional online groups with the permission of page administrators. Groups that were targeted included local youth activity, sporting and social groups or generic non-youth specific groups set up for local residents. 2. Flyers (see appendix 3) were displayed on prominent local community noticeboards, including all towns within the CVPCP catchment and were left with youth service providers to be displayed in waiting rooms with agency approval. 3. Youth service provider clinicians/staff were asked to provide flyers or hard copies of the survey (depending on internet accessibility) to all clients within the target age group. 4. Project Officers attended youth community groups and venues, youth events and sporting activities as appropriate, to distribute both hard copies of surveys and the survey web address for respondents to complete online surveys. The project officer provided the use of a tablet to enter data directly. 5. Prominent workplaces within the catchment were approached to display the flyer (with the survey web address) to all employees within the target age group. The youth service providers approached in each shire area were from local government (youth activities officer, youth development officer), Community Health Centres, General Practice, Neighbourhood/Community House, Carer Support Services, Mental Health Services, Emergency Accommodation Support Services, Youth Homelessness Officer, and other specific youth programs in each shire. Participants were offered a movie ticket voucher to a local cinema of their choice or a Subway voucher as compensation for taking time to complete the survey. CVPCP Building Youth Resilience against Problem Gambling 7

8 Data Collection The youth survey was completed online with respondents directed from the CVPCP website to an online survey hosted at Online consent was sought before respondents could enter the survey. Hard copies of the survey were distributed to youth service providers for use with young people who had limited internet access; however only one hard copy was received. Data Analysis Descriptive statistics were used to summarise the characteristics of the survey respondents, describe their gambling behaviours including online gambling, motivations for gambling and influences from others, engagement in other risky behaviours, general health and wellbeing (including resilience) and help seeking attitudes. Participants were grouped according to gender, gamblers vs non-gamblers and internet gamblers vs noninternet gamblers. Group differences in variables were evaluated using chi-squared analysis and t-test as appropriate. Gamblers were those respondents who had participated in any form of gambling in the past 12 months. Internet gamblers were classified as all respondents who reported spending some time participating in gambling activities online each week. The intention had been to compare internet gamblers vs non-internet gamblers, however our measurement of internet gamblers (participation each week) was different from our measurement of other gamblers (participation in the last 12 months. Any comparison was defined by regularity of gambling rather than type of gambling, therefore the comparison group for internet gamblers was all gamblers who reported spending some time gambling each week but did not participate in internet gambling with defining regularity. Gamblers were also grouped according to whether they exhibited signs of being at risk of problem gambling or not. Risk level was identified using some of the questions from the short version of the Problem Gambling Severity Index (PGSI-Short Form) and the rating scale developed and evaluated in previous research (Williams & Volberg, 2012). This research indicated that a cut-off of one or more on the PGSI-Short-Form is a very good indicator of the proportion of the population that is negatively affected by their gambling, in other words, at risk of problem gambling. It also concludes that a cut-off of 2 or more is an indicator of at least moderate risk, and a score of 3 or more is an indicator of problem gambling. For this report, gamblers have been grouped into two groups; at-risk gamblers (a score of at least one) and the other not-at-risk gamblers (a score of 0). The group differences were then analysed using the methods discussed above. Youth Service Providers Survey The youth service providers survey (see appendix 4) was developed by the project officer in consultation with CVPCP staff and the CVPCP Problem Gambling Working Group. The aim of the youth service providers survey was to gather information about the impact of problem gambling on their clients and agencies, referral processes, processes of screening or identification of risks, intervention, prevention and early intervention for young people at risk of gambling related problems. Recruitment of participants Chief Executive Officers and managers at agencies providing youth services in each shire were approached to distribute the service providers' survey to appropriate staff. Data Collection The youth service providers survey was also available online and could be accessed through the CVPCP website. These participants also provided consent to participate. Data Analysis Data was analysed using descriptive statistical methods and thematic analysis. CVPCP Building Youth Resilience against Problem Gambling 8

9 Youth Service Providers Focus Groups The focus groups held in each shire were unstructured and the content was designed based on the results of the youth service providers survey. The aim of the focus groups was to explore in more depth some of the issues raised by the survey. Four themes that emerged from the survey were explored further at the focus groups. These included: screening and identification of risk, referral processes, awareness of problem gambling and capacity building requirements. Recruitment of participants On completion of the service providers' survey, respondents were invited to attend the focus groups, and details of the focus group and a participant information form were provided. A copy of this invitation was also sent to all managers who were contacted prior to the survey, ensuring that managers were aware of the focus groups and could provide approval for their staff's attendance. Initially responses to the invitations were low, so a reminder and invitation was sent out to all youth service providers previously contacted. Data Collection Focus group data was collected by way of audio recordings and notes taken by the moderator. Data Analysis Focus group data in the form of audio recordings and notes taken by moderator and assistant moderator was summarised (full transcription of data was not be performed). The summarised data underwent a content analysis consisting of identification of themes, including the use of simple statistical frequencies. CVPCP Building Youth Resilience against Problem Gambling 9

10 RESULTS A) Youth Survey Survey participants The number of people who entered the survey was 97, however due to ethics requirements answering all questions was not compulsory, so respondent numbers for individual questions vary. The highest number of respondents to any one question is 85 (87.6% of those that entered the survey). Table 1 below summarises the characteristics of respondents. Table 1 : Characteristics of Survey Participants % n Gender (N=76) Male Female Shire of Residence (N=75) Central Goldfields Shire Macedon Ranges Shire Mount Alexander Shire Other Employment Status (N=72) Work Full-time Work part time or casual Unemployed and looking for work Full-time student Full-time home duties Sick or disability pension Speak a language other than English at home (N=76) Yes No There were a similar number of males and females who responded to the survey. Of 75 respondents, 44% lived in Mount Alexander Shire, there were 17 respondents (22.7%) from both Central Goldfields and Macedon Ranges Shires. Just over half (54 %) of respondents were working either full-time or casually, with 28% full-time students and 14% unemployed. Just over one tenth spoke a language other than English at home. Gambling behaviours of young people Sixty five respondents (76.5%) reported participating in at least one gambling activity in the past 12 months, this defined them as gamblers. Twenty (23.5%) had not gambled at all in the past 12 months, they were classed as nongamblers. Table 2 looks at the different characteristics between gamblers and non-gamblers. Table 2 : Characteristics of Gamblers vs Non-gamblers Gamblers Non-gamblers % n % n Gender (N=76) Male Female Shire of Residence (N=77) Central Goldfields Shire Macedon Ranges Shire Mount Alexander Shire Other CVPCP Building Youth Resilience against Problem Gambling 10

11 Gamblers Non-gamblers % n % n Employment Status (N=72) Work Full-time Work part time or casual Unemployed and looking for work Full-time student Full-time home duties Sick or disability pension Speak a language other than English at home (N=76) Yes No A little over half of all gamblers were males (52.5%), however 84% of all males compared with 72% of females had gambled in the past 12 months, this is not a significant difference. Macedon Ranges Shire (88%) had the highest proportion of gamblers in this survey. A higher proportion of gamblers worked (57.6%) compared with nongamblers (29.4%, p=0.04), while more non-gamblers were students (47.1%) compared with gamblers (20.3%, p=0.02). In order to gauge the current gambling behaviours of young people, the survey questioned respondents about their participation in a range of gambling activities in the past 12 months. Respondents were also asked about the frequency and amount of time spent participating in these activities per week. Overall, the most popular types of gambling activities were Electronic Gaming Machines/Pokies (63% of gamblers), lottery tickets (61%) and Instant scratch tickets (57%). Sports betting (46%) and betting on horse or dog races (42%) were also popular forms of gambling with young people. The reported gambling by occurrence is shown in Table 3. Table 3 : Frequency of gambling in the past 12 months by type (% of gamblers, N=65) More than once a week % (n) N=2 Once a week % (n) N=10 A few times a month % (n) N=10 Once a month % (n) N=19 Less than once a month % (n) N=62 Not in the last 12 months % (n) N=62 Instant Scratch tickets 0 (0) 3 (2) 4.6 (3) 6 (4) 43.4 (28) 43.4 (28) Lottery tickets 0(0) 7.8 (5) 1.6 (1) 6.3 (4) 45.3 (29) 39 (25) Sports betting 1.5 (1) 6.2(4) 3 (2) 9.2 (6) 26 (17) 54.1 (35) Horse/dog race betting 1.5 (1) 7.7 (5) 4.6 (3) 7.7 (5) 20 (13) 58.5 (38) Bingo for money 0 (0) 1.5 (1) 0 (0) 4.6 (3) 6.2 (4) 87.7 (57) Keno 0 (0) 1.5 (1) 1.5 (1) 2 (2) 15.4 (10) 79.6 (51) Poker for money 1.5 (1) 1.5 (1) 0 (0) 2 (2) 15.4 (10) 79.6 (51) Casino table games 0 (0) 1.5 (1) 1.5 (1) 4.6 (3) 21.5 (14) 70.9 (46) Games of skill for money 2 0 (0) 2 (2) 0 (0) 2 (2) 10.8 (7) 85.2 (53) Electronic gaming machines (Pokies) 1.5 (1) 6.2 (4) 6.2 (4) 12.3 (8) 36.9 (24) 36.9 (24) There are very few people who report a high frequency of gambling (Table 3). The average number of different types of gambling participated in over the last year was 3.7. Frequency of gambling by gambling type indicated that in this sample horse/dog betting had the highest proportion of respondents participate at least weekly (9.2%), this 2 Includes arcade, puzzle, word, trivia and fantasy sport games. CVPCP Building Youth Resilience against Problem Gambling 11

12 was followed by lottery tickets (7.8%), sports betting (7.7%) and EGM s (7.7%). When looking at the amount of time spent participating in gambling activities each week, only 11.1% of gamblers reported spending more than an hour and no one spent more than 3-5 hours a week (Table 4). Table 4: Time gamblers spent gambling each week N=63 % n None Less than one hour hours hours hours hours 0 0 More than 20 hours 0 0 Characteristics and gambling behaviours of at-risk gamblers vs not-at-risk gamblers Gamblers were further classified according to whether they exhibited signs of being at risk of problem gambling or not (see methods section of this report for classification details). Table 5 depicts the different characteristics between at-risk and not-at-risk gamblers. Table 5 : Characteristics of At-risk vs Not-at-risk Gamblers At-risk gamblers N=24 Not-at-risk gamblers N=39 % n % n Gender N=58 Male Female Shire of Residence N=60 Central Goldfields Shire Macedon Ranges Shire Mount Alexander Shire Other Employment Status N=57 Work Full-time Work part time or casual Unemployed and looking for work Full-time student Full-time home duties Sick or disability pension Speak a language other than English at home N=59 Yes No This data indicate that males are no more likely to be at-risk of gambling problems than females, however numbers are small. Central Goldfields Shire (46.2%) had the highest proportion of respondents that were classified as at-risk gamblers with Mount Alexander Shire (25%) having the least proportion at-risk. The group of at-risk gamblers were more likely to work either full time or part time (81.8%) compared with not-atrisk gamblers (32.4%, p=0.0003), and less likely to be students (4.5% vs 30.6%, p=0.03). CVPCP Building Youth Resilience against Problem Gambling 12

13 The type of gambling undertaken in the previous 12 months by both groups is presented in Table 6 below. Table 6 : Type of gambling (participated in the past 12 months) by gambler type At-risk gambler Not-at-risk gambler % (n) % (n) N=24 N=39 All Gamblers % (n) N=65 Instant Scratch tickets 71 (17) 49 (19) 57 (37) Lottery tickets 57 (13) 62 (24) 60 (39) Sports betting 54 (13) 38 (15) 46 (30) Horse/dog race betting 54 (13) 69 (27) 42 (27) Bingo for money 21 (5) 8 (3) 12 (8) Keno 25 (6) 18 (7) 22 (14) Poker for money 38 (9) 10 (4) 22 (14) Casino table games 42 (10) 18 (7) 29 (19) Games of skill for money 25 (6) 11 (4) 17 (11) Electronic gaming machines (EGM s/pokies) 79 (19) 49 (19) 63 (41) Amongst gamblers, those at-risk were significantly more likely to play EGM s (p=0.016), poker for money (p=0.009) and casino table games (p=0.04) than not-at-risk gamblers. The most popular forms of gambling for those at-risk were EGM s and scratch tickets. This was different for not-at-risk gamblers who preferred betting on horse/dog races and lottery tickets. The average number of different types of gambling participated in over the last year was 4.8 for at-risk gamblers and 2.9 for not-at-risk gamblers which was a significant difference (P=0.002). As with the figures for all gamblers, the majority of at-risk gamblers tended to spend less than an hour per week on these activities (71%, 17), 16.7% (4) spent 1-3 hours/week and 12.5% (3) spent 3-5 hours/week participating in gambling activities (Table 7). Gamblers who were classified as being at-risk were more likely to spend more than one hour each week on all gambling activities compared with not-at-risk gamblers (29% vs 2.9%, p=0.003). Table 7: Time spent gambling each week by gambler type (at-risk vs not-at-risk gamblers) At-risk gamblers N=24 Not-at-risk gamblers N=37 % n % n None Less than one hour hours hours hours hours More than 20 hours Internet gambler characteristics 27.7% (18) of gamblers identified themselves as being internet gamblers by indicating that they participated in gambling activities online each week (these numbers are not consistent as answers were not compulsory). A significantly higher proportion of males (76%, 13) participated in internet gambling compared with non-internet gamblers (42%, 8 p=0.03) (Table 8). Non-internet gamblers were identified by indicating that they spent some time each week participating in gambling activities but did not spend any time each week on internet gambling (N=22). CVPCP Building Youth Resilience against Problem Gambling 13

14 Table 8 : Characteristics of Internet vs Non-internet Gamblers Internet gamblers N=18 Non-internet gamblers N=22 % n % n Gender Male Female Shire of Residence Central Goldfields Shire Macedon Ranges Shire Mount Alexander Shire Other Employment Status Work Full-time Work part time or casual Unemployed and looking for work Full-time student Full-time home duties Sick or disability pension Speak a language other than English at home Yes No Internet gamblers were more likely to work (76.4%) compared with non-internet gamblers (44.6%, p=0.012), and were less likely to be students (0% vs 28%, p=0.03). The type of gambling undertaken by these groups is presented in Table 9 below. Table 9 : Type of gambling by gambler type (internet vs non-internet) Internet gambler % participated in the past 12 months (n) N=18 Instant Scratch tickets 61 (11) 73 (16) Lottery tickets 61 (11) 71 (15) Sports betting 72 (13) 41 (9) Horse/dog race betting 67 (12) 36 (8) Bingo for money 33 (6) 4 (1) Keno 39 (7) 18 (4) Poker for money 39 (7) 18 (4) Casino table games 56 (10) 36 (8) Games of skill for money 44 (8) 5 (1) Electronic gaming machines (EGM s/pokies) 83 (15) 68 (15) Non-internet gambler % participated in the past 12 months (n) N=47 Compared with non-internet gamblers, internet gamblers were significantly more likely to play games of skill (p=0.003), bingo (p=0.008), and sports betting (p=0.047). They were also more likely to play EGM s more than once a week than non-internet gamblers (27% (5) vs 0%, p=0.008). The most popular forms of gambling for internet gamblers was EGM s, followed by sports betting, horse/dog betting, and then lottery and scratch tickets. This was different for non-internet gamblers who preferred lottery tickets and scratch tickets then EGM s. CVPCP Building Youth Resilience against Problem Gambling 14

15 The average number of different types of gambling participated in over the last year was 5.6 for internet gamblers and 3.7 for non-internet gamblers which was a significant difference (P=0.01). The majority of internet gamblers tended to spend less than an hour per week on these (66.7%); 27.8% spent 1-3 hours and 5.5% (1) spent 3-5 hours weekly participating in internet gambling activities. This pattern of length of gambling time (hours per week) is similar to that of all gamblers. Table 10: Time internet and non-internet gamblers spent gambling each week Internet gamblers N=18 Non-internet gamblers N=22 % n % n None Less than one hour hours hours hours hours More than 20 hours Of all gamblers surveyed, 43% had utilised free gambling websites which is thought to be one of the ways that many internet gamblers are initiated into online gambling activities. The majority of internet gamblers reported that they had accessed the internet from home (89%), with the device used split equally between computer and mobile phones. Internet gamblers indicated that their main reasons for gambling online were the convenience and accessibility of online gambling rather than their dislike of land-based venues or their physical comfort of gambling from home (see Table 11 below). There were many respondents who answered this question who were not classified as internet gamblers. It is unclear as to whether their answers refer to reasons they would gamble online or that they have gambled online and didn t meet the criteria for internet gambler, for interest these results are also included in Table 11 below. Table 11: Main reasons for gambling online Internet Gamblers N=18 All respondents N=54 % n % n Convenience more convenient access online Access unable to easily access land-based venues Privacy/Anonymity Price including bonuses, free credit, odds, payout rates Use of free play sites Advertising/marketing Greater number of betting options and games available Dislike or discomfort with land-based venues Physical comfort of gambling at home Internet gamblers were significantly more likely to be classified as being at-risk of problem gambling (71%, 12) compared with non-internet gamblers (39%, 9, p=0.048). Both at-risk and not-at-risk gamblers reported the main reason for participating in internet gambling was convenient access (45% at-risk vs 50% not-at-risk). At-risk gamblers tended to be more concerned with privacy/anonymity (30% CVPCP Building Youth Resilience against Problem Gambling 15

16 vs 0%, p=0.002), which was the only significant difference between the groups. However, at-risk gamblers more often identified accessibility (they were unable to easily access land-based venues, 25% vs 7%) and price including bonuses etc (15% vs 4%) as reasons for participating in online gambling. Not-at-risk gamblers more often reported gambling online due to the physical comfort of gambling at home (15%) compared with at-risk gamblers (0%). Both groups had similar numbers of respondents gambling online due to the access to free play sites. Table 12 below details this data. Table 12 : Main reasons for gambling online risk vs not-at-risk gamblers At-risk gamblers % (n) N=20 Convenience more convenient access online 45 (9) 59 (16) Access unable to easily access land-based 25 (5) 7 (2) Privacy/Anonymity 30 (6) 0 (0) Price including bonuses, free credit, odds, payout rates 15 (3) 4 (1) Use of free play sites 25 (5) 33 (9) Advertising/marketing of online gambling options 10 (2) 15 (4) Greater number of betting options and games available 5 (1) 7 (2) Dislike or discomfort with land-based venues 5 (1) 4 (1) Physical comfort of gambling at home 0 (0) 15 (4) Not-at-risk gamblers % (n) N=27 Influences for gambling The contexts for youth gambling were investigated by looking at peer and family influences on gambling and motivations for gambling. Motivations for gambling Overall the most common reasons for gambling were for entertainment (69%, 38), to win money (53%, 29) and to be sociable (35%, 19). The least common responses were to avoid talking to people (0%), to escape from problems (4%, 2) and to forget troubles (5%, 3). Respondents were encouraged to indicate as many answers as applied. The reasons for gambling varied amongst the different classifications of gamblers, however the most common reasons across all groups was for entertainment and winning money. Table 13 below shows the reasons for gambling between at-risk and not-at-risk gamblers, and Table 14 indicates the same for internet and non-internet gamblers. There were no significant differences between the groups. Table 13: Motivations for gambling: At-risk vs not-at-risk gamblers At-risk gamblers % (n) N=21 For entertainment 71 (15) 54 (21) To win money 57 (12) 36 (14) To be sociable 29 (6) 28 (11) To forget troubles 10 (2) 3 (1) To escape from problems 5 (1) 3 (1) For something to do 33 (7) 10 (4) For excitement 33 (7) 21 (8) To avoid talking to people 0 (0) 0 (0) Not-at-risk gamblers % (n) N=39 CVPCP Building Youth Resilience against Problem Gambling 16

17 Table 14 : Motivations for gambling: Internet vs Non-internet gamblers Internet gamblers % (n) N=18 For entertainment 72 (13) 59 (13) To win money 50 (9) 41 (9) To be sociable 28 (5) 36 (8) To forget troubles 11 (2) 5 (1) To escape from problems 11 (2) 0 (0) For something to do 17 (3) 32 (7) For excitement 22 (4) 36 (8) To avoid talking to people 0 (0) 0 (0) Non-internet gamblers % (n) N=22 Influences from others In order to look at whether the influence of others had an impact on young respondents gambling we asked questions about the gambling habits of family members and peers. The number of responses to this question is equal to the highest response rate in this survey (87.6%, 85) Peers Overall respondents had an average of 1.24 friends who regularly gamble. Gamblers (n=65) had on average significantly more friends who regularly gambled than non-gamblers (n=20) (1.46 v 0.5, p=0.0003). Males (n=37) also on average had significantly more friends who regularly gambled compared with females (n=39) (1.6 vs 0.9, p=0.01) and were more likely to have more than one friend who did this (p=0.002). At-risk gamblers (n=24) were more likely to have more than one friend who regularly gambled (62.5% vs 33.3%, p=0.02), but there was no significant difference in average number of friends involved (1.8 for at-risk vs 1.3 for norisk gamblers (n=39)). Internet gamblers (n=18) had the highest average number of friends participating in gambling activities (2.17) but this was not significantly higher than non-internet gamblers (1.6, n=22). Family Overall, families of respondents did not gamble at all in the past 12 months (28.2%, 24) or gambled less than once a month (27.1%, 23). Of the 85 respondents, 8.3% (7) had family members who gambled more than once a week. There was no significant difference between comparison groups about the frequency of family members gambling. Risky behaviours Problems with gambling have often been linked with other risky behaviours such as alcohol and substance use. Respondents were asked about their use of drugs and alcohol when gambling; results are presented in Table 15 below. From a sample of 59 gamblers, 49.2% (29) reported having used alcohol when gambling and 6.8% (4) reported having used drugs. Males were more likely to have used both alcohol (p=0.002) and drugs (p=0.03) compared with females. Internet gamblers were more likely to have used drugs while gambling (p=0.02) compared with non-internet gamblers. CVPCP Building Youth Resilience against Problem Gambling 17

18 Table 15 : Drug and alcohol consumption whilst gambling Alcohol % (n) Drugs % (n) All gamblers 49 (29) 7 (4) Males 54 (19) 11 (4) Females 28 (11) 0 (0) Internet Gamblers 59(10) 24 (4) Non-internet gamblers 55 (11) 0 (0) At-risk gamblers 61(14) 13 (3) Not-at-risk gamblers 43 (16) 3 (1) Health and wellbeing Overall Health Status Self-rated health status was measured on a scale of one to five. The average reported health status of all respondents was 4.07 out of 5; gamblers were only slightly higher at There was a significant difference in the average reported health status between at-risk (3.8) and not-at-risk gamblers (4.3, p=0.01). The mental health and wellbeing of respondents was assessed using questions from the Kessler 10 (K10) anxiety and depression scale (Dierker, et al., 2001). For the majority of questions there was no difference between comparison groups. At-risk gamblers were more likely to have reported that everything was an effort compared with not-at-risk gamblers (61% (14) vs 32% (12)). However a significant difference was observed in that non-internet gamblers (35%, 7) were more likely to have reported having felt nervous more than a little of the time over the last few months in comparison with internet gamblers (6%, 1). The small sample size is worth noting. Resilience Two questions from the brief resilience scale (Smith, et al., 2008) were asked to gain an indication of resilience to life events. Table 16 : Resilience Q.1 Do you tend to bounce back quickly after hard times? Strongly agree/agree % (n) Neutral % (n) Strongly disagree/disagree % (n) Gamblers 64.3 (38) 24.8 (13) 10.9 (5) Non-gamblers 52.9 (9) 29.4 (5) 17.6 (3) Males 73 (25) 21 (7) 6 (2) Females 55 (21) 29 (11) 16 (6) Internet Gamblers 60 (9) 27 (4) 13 (2) Non-internet gamblers 70 (14) 25 (5) 5 (1) At-risk gamblers 66.6 (14) 14.3 (3) 19.1 (4) Not-at-risk gamblers 69.4 (25) 27.8 (10) 3 (1) Q.2 Do you have a hard time making it through stressful events? Strongly agree/agree % (n) Neutral % (n) Strongly disagree/disagree % (n) Gamblers 22.3 (10) 34.2 (21) 43.5 (28) Non-gamblers 41.2 (7) 29.4 (5) 29.4 (5) Males 17 (6) 33 (12) 50 (18) Females 29 (11) 36 (14) 36 (14) Internet Gamblers 12 (2) 29 (5) 59 (10) Non-internet gamblers 20 (4) 40 (8) 40 (8) At-risk gamblers 17.4 (4) 17.4 (4) 65.2 (15) Not-at-risk gamblers 16.2 (6) 45.9 (17) 37.9 (14) CVPCP Building Youth Resilience against Problem Gambling 18

19 Table 16 above indicates that there are differences between groups, however very few of these are significant. From 21 at-risk gamblers 19% (4) indicated that they don t tend to bounce back quickly after hard times which is significantly higher than not-at-risk gamblers (3%, 1, p=0.04). Unexpectedly in the sample of non-gamblers, a greater proportion agreed that they have a hard time making it through stressful events than gamblers (41.2% (7) vs 22.3% (10) and more at-risk gamblers disagreed with this than not-at-risk gamblers (65.2% (15) vs 37.9% (14)). Social connections Overall 28% of all respondents reported that they would like to have more contact with family and friends who don t live with them and only 3% would like less contact therefore the majority (69%) were happy with the current level of contact. There was no significant difference between any of the groups analysed. When asked how often they felt lonely, 39.5% of all respondents reported feeling lonely at least sometimes. At-risk gamblers (57% vs 24%, p=0.01) were significantly more likely to report this compared with their comparison group. Table 17 below outlines the responses provided when respondents were questioned about what contributed to their feeling of loneliness. Internet and at-risk gamblers are presented separately. Lack of money and low selfesteem were the most common responses, with limited social activities and lack of places to socialise also prominent. Table 17: What contributes to these feelings of loneliness? All responses % (n) Internet gamblers % (n) At-risk gamblers % (n) Lack of money 35.1 (20) 24 (6) 41.2 (7) Low self-esteem/confidence 35.1 (20) 20 (5) 35.3 (6) Limited social activities on offer 31.6 (18) 16 (4) 35.3 (6) Lack of places to socialise 29.8 (17) 8 (2) 41.2 (7) Physical isolation 28.1 (16) 12 (3) 23.5 (4) Lifestyle differences 28.1 (16) 0 (0) 17.6 (3) Lack of transport 15.8 (9) 16 (4) 17.6 (3) Safety fears 8.8 (5) 0 (0) 5.9 (1) Health condition 5.3 (3) 4 (1) 5.9 (1) Language/cultural barriers 3.5 (2) 0 (0) 0 (0) When asked about what could be done to improve services or activities for young people, the majority of responses recommended increasing the number of activities available or increase the number and variety of facilities available (see Table 18 below). A common theme was for these places and/or activities to be available in the evenings. Table 18: What could be done to improve services or activities for young people? % n More activities for younger people e.g. sporting activities, movie nights, music/dance events, groups and classes in the evening More places for young people to hang out and socialise e.g.-sporting facility, bowling alley, night club, go karts, somewhere to just hang out with friends Better transport esp. in smaller towns Increase the awareness of youth activities CVPCP Building Youth Resilience against Problem Gambling 19

20 Seeking help To gauge the knowledge of services for people experiencing problems with gambling, respondents were asked where they would seek help if they felt they had a problem. This was open-ended, there was no prompting nor options provided for responses to this question. From 43 respondents, 47.7% (21) indicated that they would contact Gamblers Help or counselling and 29.5% (13) would turn to family and friends, 7% (3) reported that they were unsure where they would go for help and 4.7% (2) would not get help. Table 19 below outlines the reported barriers to seeking help. Overall most people reported that they felt they could self-manage the problem; that problems weren t serious enough to require help and they would be too embarrassed to seek assistance for gambling problems. Table 19 : Barriers to help seeking N=59 All responses % (n) Internet Gamblers % (n) At-risk gamblers % (n) Feel I could solve my problems myself 30.5 (18) 28 (5) 28.6 (6) Problem not serious enough 28.8 (17) 17 (3) 38.1 (8) Embarrassed 27.1 (16) 28 (5) 23.8 (5) Cost 11.9 (7) 11 (2) 9.5 (2) Inconvenience 10.2 (6) 11 (2) 28.6 (6) Not sure where to go for help 6.8 (4) 6 (1) 9.5 (2) CVPCP Building Youth Resilience against Problem Gambling 20

21 Percent B) Youth Service Providers Survey There were 16 responses to the youth service providers survey out of a total of 31 individuals from 20 different agencies that were approached. The youth service providers who responded to the survey offered a wide variety of services to young people. The most common services provided were youth group programs (38.5%), social/recreational activities (38.5%) and counselling (38.5%). See Figure 1 below for details of the services provided by respondents. Figure 1: Types of services provided Types of Services Provided Impact of problem gambling on youth service providers Youth service providers were asked about the impact that problem gambling has had on their agencies and clients, including estimates around the percentage of clients that are or may be affected by problem gambling issues. Half of the respondents replied that problem gambling has a moderate to very large impact on their agencies and clients, while the other half reported a small or very small impact on their agencies and/or clients (Table 20). Table 20 : Overall impact of problem gambling on clients and agency (N=16) % n Very Large Large Moderate 25 4 Small Very small Half (50%) of the respondents indicated that in the past 5 years the impact of problem gambling on their agencies and clients had increased. Only one agency (6.3%) reported that this impact had decreased. When asked for an estimate of the number or proportion of year olds presenting with serious problems, there was a varied response from 0-30%. Of 9 respondents who provided a percentage estimate, the median was 5% and the mean was 7.7%. Estimates of those at risk of developing gambling problems varied but were significantly higher, ranging from 5% to 60% with the average response being 20% and the median being 15%. These responses varied depending on the core activities of agencies and their intake and screening processes. Agencies reported that young clients with gambling related problems are most often presenting with financial problems (64.3%), mental health problems (50%), relationship problems (6.2%) and substance abuse (6.2%). CVPCP Building Youth Resilience against Problem Gambling 21

22 Percent Referral process The main source of referrals to agencies for young people who present with gambling related problems is varied. Self-referral and referral by family and friends are the most frequent sources. This is shown in Figure 2 below. Figure 2: Referral sources to agencies for young people with gambling related problems Of the agencies that responded, 60% indicated that they and their staff had only a poor or fair knowledge about appropriate referral pathways for young people presenting with gambling related problems. Their suggestions about how to improve this referral process included: 1. Capacity building with agencies around impacts of problem gambling on young people and services provided to manage gambling related problems 2. Improving partnerships between agencies to better co-ordinate services. 3. Increase the awareness/visibility of services that manage young people with gambling problems. 4. Improved and more consistent cross-agency screening for gambling related problems 5. Clearer referral processes. Screening/Assessment Youth service providers were asked to identify indicators that alert them to a young person being at risk of having gambling problems. The most common responses were financial (71.4%) and mental health problems (64.3%). Other responses included relationship problems (28.6%), focus on gambling (14.3%) and social isolation (7.1%). When questioned about the use of screening tools to identify problem gamblers or those at risk, 73.3% (11) of respondents reported not using any screening tools at all. Four agencies reported using screening tools but there was no consistency across the agencies as to which tool was used. These tools included the lie-bet questionnaire, and other non-gambling specific screening questions. One agency applied this screening tool at initial contact and two applied it during the initial needs identification. The fourth did not provide any information about timing of screening. The same number of agencies (11) who did not screen for gambling related problems also did not utilise any other formal assessment tools to identify young problem gamblers or those at risk of problem gambling. For those that did CVPCP Building Youth Resilience against Problem Gambling 22

23 there was again inconsistency across agencies with the Problem Gambling Severity Index (Holtgraves, 2009), Victorian Gambling Screen (Tolchard & Battersby, 2010), Gambling Ideation Scale, Work and Social Impact of Gambling, and other tools to measure co-morbidities being utilised 3. Treatment/Prevention/Early Intervention Services provided to young people at risk in this catchment consist mostly of counselling services and mental health services which are effective at the treatment end of the health promotion continuum. There are some programs that focus on social connections, social outreach and peer support which can be effective with this age group. Table 21 : Services provided to young people at risk of gambling problems or other harmful behaviours N=11 % n Counselling Mental health Social/recreational activities Youth group Peer support Employment Referral services Sporting Faith-based When asked specifically about early intervention and prevention services provided, particularly with a focus on improving young people s resilience and social connections, the most common response was around linking young people into the community including through education, work, and volunteering. Youth service providers in this catchment also provide social events, education, therapeutic work including case management aimed at increasing resilience and one response suggested youth involvement in leadership programs. Youth service providers were then asked which early intervention and prevention programs they thought would have a positive impact on gambling related and other harmful behaviours in young people in this catchment. 78% (7) of respondents felt that education would have a positive impact, specifically education in schools around gambling and its risks. Other responses included self-esteem and resilience building programs (22%, 2), peer support, social activities for young people and improved partnerships with agencies in the region. Nearly two thirds (61.5%) of agencies rated their staff s skills, knowledge and resources to effectively manage young people presenting with gambling problems as poor or fair. Four areas were identified that if addressed would improve the ability of agencies and their staff to respond to these issues. These were: capacity building around the impact of gambling, improved and more consistent screening processes, increase knowledge of correct referral process and more resources or promotional material made available from treatment services. Finally youth service providers were asked for their opinion regarding successful strategies that had helped to improve the engagement of young people prone to harmful behaviours. Suggestions included programs that are organised for youth by youth with support and guidance from youth worker; counselling; volunteering; and peer support. 3 No references could be found for some of the scales utilised CVPCP Building Youth Resilience against Problem Gambling 23

24 C) Youth Service Providers Focus Groups The three focus groups that were held (one in each shire) were designed to look further into some of the issues raised in the youth providers survey. In total, there were 13 attendees at the three focus groups held, nine in Macedon Ranges, two in Central Goldfields and two in Mount Alexander Shires. The four issues that were addressed were: screening, referral pathways, awareness raising and capacity building. Screening Attendees at the focus groups confirmed that screening, either formal or informal, for problem gambling or at-risk gambling was not common amongst youth service providers unless gambling treatment was a part of their core activity. It follows from this that youth service providers reported not seeing many young clients identified with gambling as an issue. Suggestions made around screening as a secondary prevention measure include educating staff on how to talk about how to raise or frame conversations with young people in order to ascertain risk and protective factors, and more formal screening questions that are sensitive and targeted at young people. Referrals Attendees were keen to find out more about to whom and how to refer young people at risk of gambling problems. Awareness Raising Awareness in this context refers to youth service providers awareness of the impact of problem gambling on young people, and its associated risk and protective factors. It also alludes to the awareness that community members and community groups have of this issue. Attendees all stated that raising awareness about the impacts of problem gambling within their own organisations but also with GP s, parents, teachers and youth themselves would have a large impact on attitudes and behaviours within those groups. As well as information about the impact of problem gambling, attendees identified that it is important to keep these groups informed as to how and why young people gamble and the how this is being affected by emerging technologies. Some attendees suggested linking awareness-raising around online gambling to current concerns around gaming culture as there are some cross-overs. Capacity Building The capacity building activities that were identified as being of use to youth service providers included skills to better identify young people at risk and, as mentioned, techniques to broach the topic of problem gambling with young people. Other discussion points Overall, youth service providers reported that they do not currently have the capacity to take on extra work around problem gambling prevention for various reasons including problem gambling having a low impact overall on clients and services and that there are more pressing priorities faced on a daily basis. There was agreement that early intervention and prevention programs would be best implemented in settings such as schools and sporting organisations with the added utilisation of social media to target and engage young people. Working with schools was flagged as being of benefit, however work in this setting would require dedicated resources as focus group attendees have found that teachers are overburdened and find it difficult to take on additional tasks. CVPCP Building Youth Resilience against Problem Gambling 24

25 School conversations Due to the involvement with youth service providers feedback was provided directly from a school welfare officer which prompted contact with other schools in the catchment, as new research (Derevensky, St-Pierre, Temcheff, & Gupta, 2013; Campbell, Derevensky, Meerkamper, & Cutajar, 2011) had been highlighted about both teacher and parent perceptions of youth gambling. The teachers and parents in these studies acknowledged that young people do gamble but were not aware of the seriousness or prevalence of problem gambling. Conversations with school welfare providers in the CVPCP catchment indicated that they were not concerned about students gambling behaviours and none reported having provided assistance to a student with a gambling problem. They were however aware of parents having gambling problems but had not linked this to increased risk of gambling in the student. On further discussion they could recognise that students had far more opportunities to gamble especially on the internet and could give examples of students utilising free gambling sites particularly through social media such as Facebook. They too were keen to be involved in any capacity building activities to raise the awareness of gambling related problems. CVPCP Building Youth Resilience against Problem Gambling 25

26 DISCUSSION This research presents findings related to the gambling behaviour of year olds in the CVPCP catchment and the knowledge and needs of youth service providers about preventing youth problem gambling. A specific focus was online gambling and building resilience as a way of preventing problem gambling. The effects of building resilience in young people could go far beyond just the prevention of problem gambling. Recommendations from this research are presented as a health promotion framework which will guide interventions directed at building the resilience of young people in the CVPCP catchment against problem gambling and other harmful behaviours. This section of the report will describe the limitations of this study and then discuss the findings from each subsection of respondents, before presenting the health promotion framework document. Limitations of the Study Convenience sampling was used for recruitment of respondents to the youth survey. Despite the diverse methods of recruitment that were employed, sampling bias may impact on our statistical analysis, as the sample may not be representative of the local youth population. This is evident in the fact that the respondents weren t evenly distributed across the three shires within our catchment area. This may have been due to weaknesses in the recruitment methodology or the fact that the project officer lives and works in the shire with the largest number of respondents therefore had more effective networks for recruitment. Recruitment of young people to respond to the survey did prove to be difficult, with total number of respondents being 97. This meant that for some comparisons the sample size was too small to identify significant results, therefore there may have been real differences between groups that were not identified due to the sample size. The response rate for the youth service provider s survey was satisfactory at 52%, with 16 respondents out of 31 who were approached. However, the focus groups were poorly attended with only four attendees across the three shires, and this led to more direct methods of attaining the information being used. The instrument used as the main source of descriptive information was the two surveys. The youth questionnaire was not tested for readability and comprehension with the target group; however it was reviewed by the working group which included service providers that work directly with the target group. There is also always the potential for bias or inaccuracy when participants self-report data especially when reporting on personal or taboo issues. This is known as social desirability or social approval bias and can confound research results by creating false relationships or obscuring relationships between variables, generally through under reporting of socially undesirable behaviours. Therefore we would expect that some of our estimates may in fact be larger than our results indicate. Across both of the surveys, due to ethics requirements around the sensitive nature of some of the questions, answering every question was not compulsory. This is why the number of respondents for each question varies as some people have chosen not to respond to certain questions. This may have biased the results depending on the characteristics of the people who did not complete certain questions. Another unintended consequence of our method, which was linked to the instrument, was that we were unable to identify all respondents who had participated in internet gambling over the past 12 months as we did with gamblers. Instead our internet gambler group consisted of respondents who reported participating in internet gambling weekly and non-internet gamblers were those that participated in gambling but not internet gambling on a weekly basis, this means that some of the non-internet group may have utilised the internet for gambling less than weekly so are not strictly non-internet gamblers. When comparing internet gamblers to non-internet gamblers only those respondents who participated at least weekly were included. CVPCP Building Youth Resilience against Problem Gambling 26

27 Interestingly there were a number of gamblers (8, 10%) who indicated they were not from within the CVPCP catchment area, however their residential postcode bordered on our catchment therefore their responses were included as they were obviously socially connected with our youth community. Despite the fact that we had some difficulties with recruitment and our sample of young people was not necessarily representative of the population due to recruitment methods, the fact that our findings reflect much of the current evidence means that we do tell us the story of youth gambling in our catchment and they may have some limited generalizability to other populations in Australia. A) Youth Feedback Gambler Characteristics and Behaviours In this research 76.5% of respondents had participated in some form of gambling over the past year. This correlates with previous research findings that around 85% of year olds in Australia participate in gambling each year (Purdie, et al., 2011). A higher proportion of males were gamblers compared with females, however this was not a significant difference and highlighted that in our sample females were also attracted to gambling activities. The most popular type of gambling in our survey was EGM s, with 63% of gamblers having used EGM s in the last 12 months. This was also the case for those classified as at-risk gamblers (79%) and internet gamblers (88%). Prior research has concluded that EGM s are the most popular form of gambling with problem gamblers, but also that problem gamblers tend to participate in a larger number of different gambling activities compared with nonproblem gamblers ( Department of Justice, 2009). In the current sample, at-risk gamblers also play a higher average number of different types of gambling when compared with not-at-risk gamblers (4.8 vs 2.9), as do internet gamblers (5.6 vs 3.7). The findings of this study reflect most of the characteristics of internet gamblers and their habits found in other work. Our results show that males are much more likely to participate in internet gambling than females (76% vs 29%), and that internet gamblers were also much more likely to work than non-internet gamblers (76.4% vs 44.6%). This may be indicative of the fact that money (or credit) is needed in order to gamble, and in particular for internet gambling funds (or credit) are required to access devices and internet services. The main motivations for gambling reported by all gamblers who responded in this study were for entertainment and to win money. This indicates that appropriate alternative entertainment for young people may remove some of the motivation to gamble. The response that many people are gambling in order to win money, points to a lack of judgement or lack of knowledge about the chance of winning, which may be addressed by education on the reality of gambling odds. This is backed up in the literature (Lavoie & Ladouceur, 2004). The most popular types of gambling amongst young internet gamblers in our sample were EGM s, followed by sports betting, horse/dog betting, and then lottery and scratch tickets, this is similar to previous findings (Brunelle, Cousineau, Dufour, Gendron, & Leclerc, 2009; Purdie, et al., 2011). With commentators predicting a large growth in online gambling, particularly amongst young people, participation in these forms of gambling are also predicted to increase. Where EGM s and lottery/scratch tickets are popular across both land and internet-based gambling platforms, sports and horse/dog betting appear to be most popular with internet gamblers, therefore the predicted gambling growth may have a more marked impact on the levels of sports and horse/dog betting. Current community debate centres on the ways in which gambling, in particular sports betting, is marketed to young people. The media is an important element that shapes the social environment of youth gambling. It is saturated with images that normalise and glamorise not just gambling, but many risk-taking behaviours, which has a significant CVPCP Building Youth Resilience against Problem Gambling 27

28 influence on young people who spend on average 21 hours per week watching television and thus are exposed to these images (Purdie, et al., 2011). The impact of social media and online gaming on the normalisation of gambling amongst young people is also of concern. In recent times we have witnessed a convergence of gaming, gambling and social media as evidenced by the popularity of free games like Slot mania and Texas Hold em poker on Facebook (Kinnunen, 2010). Reversing the normalisation, or de-normalising, gambling amongst young people may be key to reducing the risk of problem gambling. De-normalisation would require activity that aims to challenge the prevailing culture supporting the normalisation of gambling, especially internet gaming and gambling within the youth culture. Community-led initiatives (community action) can embed behavioural change amongst communities, but can also be used to influence social change (Talbot, 2009). As a pre-curser to community action both the young people in our communities and organisations that support them would require appropriate knowledge about the issue of youth problem gambling and the capacity and skills required for effective advocacy for social change. Engaging young people in all stages of the planning and implementation of prevention programs is one way of building their knowledge and capacity to take further action. The literature shows a strong link between problem gamblers and internet gamblers, with internet gamblers more likely to be problem gamblers than non-internet gamblers (10% vs 3%) (Gainsbury, Hing, Blaszczynski, & Wood, 2011). The current study has also identified that internet gamblers tend to exhibit some of the same characteristics as problem gamblers. Nearly three quarters (71%) of the internet gamblers in this study were also classified as being at-risk. Internet gamblers in our study participated in a wider variety of gambling activities, and were more likely to participate in other risky behaviours, which support earlier findings (Gainsbury, Hing, Blaszczynski, & Wood, 2011). Internet gamblers indicated that their main reasons for gambling online were linked to the convenience and accessibility of online gambling rather than the physical comfort of gambling from home or their dislike of landbased venues. In rural and regional areas where access to gambling venues is limited, the advent of internet gambling provides opportunities to initiate greater numbers of new gamblers and as a consequence, potentially new problem gamblers. The current research was able to confirm some of the widely accepted factors that are associated with problem gambling in young people within this sample. Those at-risk were more often males, who are more likely to participate in other risky behaviours and report poorer social connections and poorer general health. Despite family history of problem gambling being a risk factor for young people developing problem gambling (Gupta & Derevensky, 1997; Delfabbro, Lahn, & Grabosky, 2005), our cohort of young people showed no significant familial influence. Instead there was a strong influence from peers for at-risk gamblers. Peer influence, as both a protective and risk factor, has been highlighted in the literature as having one of the strongest relationships with being a problem gambler (Dickson, Derevensky, & Gupta, 2008). This highlights a potential target group or avenue for prevention strategies. The location that young people live in, whether it be rural or remote, may also have an impact on gambling behaviours, particularly when they rely on others for transport. Lack of access to alternative social activities and general physical isolation particularly due to transport issues were cited as contributing to lack of social connections. This same lack of access, which is more common in rural and remote areas, was also cited as one of the main reasons people participated in online gambling, again highlighting the increased vulnerability of this group of young people. There are also some other well tested and validated correlates of problem gambling that were not reflected in this current research, the main one being the existence of mental health problems, in particular anxiety or depression, amongst those at-risk. This may have been due to the small sample size or the way that we categorised those at-risk. CVPCP Building Youth Resilience against Problem Gambling 28

29 In this sample, at-risk and internet gamblers were significantly more likely to report having felt that everything was an effort at some point over the last few months. This was the only measure which identified a poorer mental health outcome for at-risk groups. Other data sources indicate that mental health issues have been a problem within our catchment both for the general adult population and in adolescents. Between 2003 and 2007, compared to the Regional Victoria and Victoria average, all LGAs in the CVPCP region had a higher rate of deaths from suicide or self-inflicted injuries in population aged 0 74 years. In 2007/08, five of the CVPCP catchments seven SLAs had a higher rate of selfreported mental and behavioural problems in males and females than the Victorian average (Public Health Information Development Unit, 2011). For adolescents, which includes year olds, the hospitalisation rate for intentional self-harm was greater than the rate in Victoria (1.0 vs 0.6 per 1,000 adolescents) (DEECD, 2011). When asked about what could be done to improve services or activities for young people, the majority of responses indicated a need for more available activities or an increase in the number and variety of facilities available. A common theme was for these places and/or activities to be available in the evenings. These suggestions can be linked to addressing the resilience of young people in the catchment as discussed below. Resilience Resilience is described as the ability to bounce back from hard times or stressful events (Smith, et al., 2008). It has been used to explain why some young people who are exposed to high levels of risk do not engage in problem behaviours (Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007). In essence, it relates to the existence of protective factors, these may be individual characteristics (problem solving skills, social competence, autonomy and a sense of purpose and future), quality of relationships including with peers, family and community settings (i.e. schools workplaces) or broader environmental factors (quality schools, safe neighbourhoods and regulatory activities) (Greenberg, 2006; Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007; Derevensky, Gupta, Dickson, & Deguire, 2005). Gambling research (Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007), has found that as exposure to protective factors increases, gambling severity decreases and as exposure to risk increases, conversely gambling severity increases. Family cohesion and school connectedness have been found to be effective protective factors for preventing problems with gambling (Dickson, Derevensky, & Gupta, 2003). Other protective factors identified in the literature on youth and risky behaviours which may also impact on youth at risk of gambling problems include: 1) neighbourhood resources, 2) models for conventional behaviour, 3) controls against deviant behaviour (particularly by parents) and 4) opportunities for participation in alternative activities (Derevensky, Gupta, Dickson, & Deguire, 2005). It is important to note that protective factors don t necessarily promote resilience if the strength and number of risk factors outweigh the impact of the protective factors. It is therefore vital that prevention efforts target risk prevention alongside the promotion of protective factors. It is equally important that strategies aimed at building youth resilience occur across all the different settings in which risk and protective factors can influence young people, including at the individual level, amongst their social settings and relationships, and broader community environments. In this research, resilience as an overall construct was measured by assessing self-reported ability to bounce back from hard times and whether young people have a hard time making it through stressful events. The results to these questions were variable, on one hand at-risk gamblers reported tending not to bounce back as quickly after hard times when compared to not-at-risk gamblers. However, in terms of their ability to make it through stressful events, non-gamblers and not-at-risk gamblers reported more difficulties than their comparison groups. Further research has indicated that resilience is a dynamic variable depending on the current circumstances of the person CVPCP Building Youth Resilience against Problem Gambling 29

30 and the domain in which they need to be resilient (e.g., emotional, behavioural, educational), and that people will often be resilient in one or more domains but rarely in all (Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007). This dynamic characteristic of an individual s resilience makes it difficult to measure with any accuracy, particulalry in the cross-sectional self-reported style that we adopted. In retrospect, it would have been more valuable to measure resilience by looking at the presence of protective factors in combination with risk factors. The sole protective factor analysed in the current research was the social connection of respondents. This included their self-reported feelings of loneliness, satisfaction with level of social connections and reasons for these responses. At-risk gamblers were significantly more likely than not-at-risk gamblers to report feeling lonely (57% vs 24%), so building social connections amongst this group would be one way of promoting resilience. Lack of money, low self esteem and lack of places and activites in which to socialise were the most common responses as to why young people felt lonely. Overall, the youth survey supports much of the prior research regarding youth gambling, in particular that about online gambling. Our findings identify that there are young people at risk of problems with gambling in our catchment and confirm internet gambling as a concern, as our internet gamblers have exhibited traits that are commonly aligned with those at risk. The impact of problem gambling on the wellbeing of our young residents will most likely increase as internet gambling becomes more widespread. The current report has also gone some way to confirming that resilience has an impact on outcomes, and that prevention of gambling problems must incorporate risk prevention and promotion of protective factors in order to build resilience. B) Youth Service Providers Feedback The most common theme across all youth service providers, except those who provide gambling related interventions, was the perception that problems with gambling were not significant when compared with other issues facing their young clients. Despite this, when asked to estimate the percentage of their young clients that present with serious problems the average figure provided was 7.7%, which is similar to that from the literature being 5-7% (Purdie, et al., 2011). There was some inconsistency in the opinions about whether gambling was the cause of problems for youth or was a result of other issues facing young people and simply magnified these pre-existing problems. Some of the most common and immediate issues that youth service providers reported facing include financial, mental health, housing and relationship problems. Whether gambling is the cause or the result of these problems, this is an indication that young people may be presenting with risk factors but without protective factors. Addressing both risk and protective factors may prevent the progression of these issues. The low awareness of and lack of importance placed on gambling as an issue for young people is due in part to its competition with more immediate challenges facing service providers. This makes it difficult to advocate for problem gambling to become a priority because it has low visibility and urgency. The limited resources available for health promotion activities within agencies compound this issue. The challenge then, for those looking to address the prevention of problem gambling, is how to reframe the issue in terms that will encourage service providers to engage with the issue. One way would be to focus on developing responses that aim to increase protective factors and reduce risk factors, which also has an impact on other areas of focus including alcohol and other drugs, mental wellbeing, crime, disengagement and social connection. Youth service providers recommended a variety of strategies that would act to address many issues encountered in their work, these included peer support, alternative activities and individual resilience programs. Another avenue to engaging service providers in the prevention of problem gambling would be to increase its prominence by placing problem gambling alongside other significant issues facing young people. The following evidence highlights examples of where this approach could be relevant locally. CVPCP Building Youth Resilience against Problem Gambling 30

31 New research has suggested that problem gambling is a significant risk factor for family violence. Amongst a group of help-seeking family members of problem gamblers, over half (52.5%) reported some form of family violence in the past 12 months and most of these reported that the gambling preceded the family violence (Suomi, et al., 2013). Another example is a local report by St Luke s Anglicare (Galvin, 2012) which took a snapshot of clients accessing emergency relief agencies over a two week period. Key findings indicated that of 63 adults who completed the survey, households reported both losing more than they can afford at least sometimes (25%), suffering due to adverse health results from gambling (24%) and experiencing some financial hardship due to gambling (27%). These are just two clear examples where partnerships could be utilised to address multiple inter-related issues. Capacity building for service providers to raise awareness about youth gambling and its impacts as well as improving the identification of risk factors would benefit young people at risk. However, positioning the prevention of problem gambling as part of an approach to building the resilience of young people against a variety of problem behaviours would ensure greater sustainability and a more widespread impact. This type of broad multi-faceted approach would provide the opportunity for agencies to incorporate strategies across many areas of youth service provision where risk and protective factors overlap including alcohol and other drugs, mental wellbeing, crime, disengagement and social connection. Given competing priorities, this approach may result in better buy-in from service providers. CVPCP Building Youth Resilience against Problem Gambling 31

32 Health Promotion Framework To support the implementation of strategies identified as a result of this current research, a one page health promotion framework document has been produced. This document outlines the target populations, settings, overarching principles, protective and risk factors, and local strategies that will help to build resilience against problem gambling in youth from the CVPCP catchment. Each of these areas has been discussed in some detail below. Target populations and settings in which to build the resilience of young people against problem gambling have been identified from feedback provided by young people and youth service providers, but also the literature. Respondents to the current study identified important influences from persons close to young people. In addition to this, recent literature has identified that both parents and teachers fail to recognise the seriousness of gambling despite acknowledging the prevalence of gambling amongst youth populations (Derevensky, St-Pierre, Temcheff, & Gupta, 2013). Derevensky, Gupta, Dickson, & Deguire (2005) suggest that some overarching principles, initially proposed by Nation et al (2003), may be used to guide the appropriateness of strategies to particular target groups. Nation s review of reviews looks at effective prevention programs across four areas of youth prevention; substance abuse, risky sexual behaviour, school failure, and juvenile delinquency. The principles of effective prevention programs identified in the study also cross over into other areas of youth prevention work, including problem gambling prevention. The main principles that apply to the current report include that programs are comprehensive; appropriately timed; socioculturally relevant and foster positive relationships. These principles are described further below: The comprehensiveness of prevention programs relates to the fact that the most successful programs consist of multiple interventions across multiple settings. Therefore engaging all systems that have an impact on the problem behaviour. Interventions aimed at young people should be also be timed so that they have a maximal impact on their lives. Often programs occur too early when young people are not developmentally ready to process the information or too late when unwanted behaviour is already present. The sociocultural relevance of prevention programs to the target group plays a large part in producing positive outcomes. One way of ensuring relevance is to engage the target group in all stages of planning and implementation of prevention programs. The Mount Alexander Shire Youth Engagement Charter (MASC, 2013) is a recently produced guideline aimed at improving youth engagement in shire matters. Many learnings from this document are applicable to all agencies engaging with youth. Programs that provided opportunities for young people to develop positive relationships were shown to have positive outcomes. Relationships looked at included peer, parent-child and those between children and significant others. Positive adult relationships were seen as critical. Risk and protective factors have been collated from various sources (Derevensky J. L., 2005; Greenberg, 2006; Lussier I. D., 2007; Shead, Derevensky, & Gupta, 2010). Many of these are backed up by the current research as discussed. The suggested strategies presented in the framework are drawn from the current research, which has provided guidance on the needs and capacity that local organisations require in order to take action to prevent problem gambling in their young populations. The strategies have been presented in terms of the continuum of health promotion interventions developed by the Victorian Department of Human Services, see figure 3 (Victorian Department of Human Services, 2003). CVPCP Building Youth Resilience against Problem Gambling 32

33 Figure 3: Continuum of Health Promotion Interventions Although many of the learnings may be applicable in other catchments, particularly in rural areas, the framework is intended to be used by agencies within the Central Victorian PCP catchment area, in order to guide planning for activities that aim to build the resilience of young people. CVPCP Building Youth Resilience against Problem Gambling 33

34 CONCLUSION Young people are immersed in a society and youth culture that is full of the opportunities that technology can provide and where risky or harmful behaviours, including gambling, are often normalised and glamorised due to the influence of the media and social media networks. The growth of online gambling opportunities is of concern in rural and regional areas particularly as it has the potential to attract new problem gamblers where previously access was limited. This paper presents information obtained through qualitative methods to describe the gambling behaviour of year olds within the CVPCP catchment area, and the existing knowledge and needs of youth service providers. It has identified that around one third of respondents to the survey may be at risk of gambling related problems and has also gone some way to confirming that resilience has an impact on outcomes. In addition, it has identified strategies that will contribute to the prevention and early intervention of gambling related problems. This information has been summarised in a one page health promotion framework document. It is clear in the literature that collaboarative strategies working at different levels can be the most successful in building youth resilience. The collective impact of these strategies will be beneficial for the prevention of gambling related problems, but will also contribute a protective effect for other problematic issues facing young people including alcohol and other drugs, mental wellbeing, crime, disengagement and social connection. The prevention of gambling problems must incorporate risk prevention and promotion of protective factors in order to build resilience, and that this should be done in a collaborative manner with multiple interventions across multiple settings in order to achieve effective and widespread results CVPCP Building Youth Resilience against Problem Gambling 34

35 Young people Youth Service Providers Timing intervention should be timed to have maximal impact on a young persons life Broader Environmental Safe neighbourhoods Regulatory activities (eg govt/council policies) Opportunities for participation in alternative activities Opportunities for community engagement Settings and Supportive Environments Support priority settings to embed multi-faceted health promotion programs including policies that promote resilience Provision of alternative leisure and recreational faciltiies Improve partnerships between agencies to provide an integrated health promotion approach to addressing youth problem gambling Building youth resilience against problem gambling in the CVPCP catchment: Target populations Disengaged Youth Teachers a health promotion framework Young internet gamblers Parents Comprehensiveness include multiple interventions across multiple settings Resilience Building/Protective factors Social Social connections Cohesive, supportive family Modelling for conventional behaviour Controls against deviant behaviours (particularly by parents) Interested adults Individual Problem solving skills Social competence Autonomy Sense of purpose and future Value on achievement Value on health Overarching Principles Schools Health agencies Socio-cultural Relevance-norms, cultural beliefs and practices of the target population 4 Broader Environmental Access to gambling activities Positive media portrayal of gambling Normalisation of gambling culture Priority settings for action Sporting and recreation clubs Councils Risk Factors Social Parental or peer conflict Models for deviant behaviour (particularly peers) Poor social connections Community/school disengagement Prevention and Early Intervention Strategies identified for the CVPCP region Community Action Support young people with the development of skills and knowledge so that they can initiate community action Provide opportunitites for young people to be involved in community action activities Advocating for policy change to build protective and reduce risk factors at organisational, local, state and federal levels Social Marketing/Health Information Community education to raise awareness about youth gambling and its risks and their association with other youth issues Increase awareness of help services for early intervention Utilisation of social and other forms of media to communicate about youth activities and problem gambling awareness Education to raise the awareness of the benefits of resilience and connectedness for youth. Health Education and Skill Development Individual resilience building programs Education about gambling, the risks and links with other youth cultures e.g. sporting, gaming (to young people, parents, teachers) Capacity building for youth service providers to understand the current status of youth gambling Workplaces Community Groups Positive Relationships-peer, parent and significant others Individual Male Risk-taking Low self-esteem/coping skills Impulsive Anxiety/depression Family history of gambling Early onset of gambing experience Screening/Individual Risk Assessment Screening and referral consistency across agencies Capacity building about how to speak with young people about gambling problems Capacity building to increase knowledge about identification of risk factors and protective factors 4 (see MASC Youth Engagement Charter overleaf for further guidance) 35

36 CVPCP Building Youth Resilience against Problem Gambling 36

37 References Department of Justice. (2009). A study of gambling in Victoria: problem gambling from a public health perspective. Melbourne: Department of Justice. Aino Suomi, A. C.-M. (2013). Problem gambling and family violence: family member reports of prevalence, family impacts and family coping. Asian Journal of Gambling Issues and Public Health, 3(13), Brunelle, N., Cousineau, M. M., Dufour, M., Gendron, A., & Leclerc, D. (2009). A look at the contextual elements surrounding Internet gambling among adolescents. 8th Annual Conference of Alberta Gaming Research Institute. Alberta. Campbell, C., Derevensky, J., Meerkamper, E., & Cutajar, J. (2011). Parents perceptions of adolescent gambling: A Canadian national study. Journal of Gambling Issues, 25, Delfabbro, P., Lahn, J., & Grabosky, P. (2005). Adolescent gambling in the ACT. Canberra: Australian National University, Centre for Gambling Research. Derevensky, J. L., Gupta, R., Dickson, L., & Deguire, A. E. (2005). Prevention efforts toward reducing gambling problems. In Derevensky, Gambling Problems in Youth (pp ). US: Springer. Derevensky, J., St-Pierre, R., Temcheff, C., & Gupta, R. (2013). Teacher awareness and attitudes regarding adolescent risky behaviours: Is adolescent gambling perceived to be a problem? Journal of Gambling Studies. Dickson, L., Derevensky, J. L., & Gupta, R. (2008). Youth gambling problems: Examining risk and protective factors., 8(1),. International Gambling Studies, Dickson, L., Derevensky, J., & Gupta, R. (2003). Youth gambling problems: The identification of risk and protective factors. Ontario: Ontario Problem Gambling Research Centre. Dierker, L. C., Albano, A., Clarke, G. N., Heimberg, R. G., Kendall, P. C., Merikangas, K. R., & Kupfer, D. J. (2001). Screening for anxiety and depression in early adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40(8), Gainsbury, S., Hing, N., Blaszczynski, A., & Wood, R. (2011). An investigation of Internet gambling in Australia. Galvin, L. (2012). St Luke's Anglicare Submission: Inquiry into the social and economic costs of problem gambling in Victoria. Bendigo: St luke's Anglicare. Greenberg, M. T. (2006). Promoting resilience in children and youth. Annals of the New York Academy of Sciences, 1094(1), Griffiths, M. D. (2005). A "components" model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, Gupta, R., & Derevensky, J. (1997). Familial and social influences on juvenile gambling behavior. Journal of gambling studies, 13(3), Holtgraves, T. (2009). Evaluating the problem gambling severity index. Journal of gambling studies, 25(1), Kinnunen, J. (2010). Convergence of online gambling and social media. 8th European Conference on Gambling Studies and Policy Issues (pp ). Finland.: University of Tampere. 37

38 Lussier, I., Derevensky, J., Gupta, R., Bergevin, T., & Ellenbogen, S. (2007). Youth gambling behaviors: An examination of the role of resilience. Psychology of Addictive Behaviors, 21(2), MASC. (2013). Mount Alexander Shire Council Youth Engagement Charter. Nation, M., Crusto, C., Wandersman, A., Kumpfer, K., Seybolt, D., Morrissey-Kane, E., & Davino, K. (2003). What works in prevention: Principles of effective prevention programs. American Psychologist, 58(6-7), 449. Productivity Commission. (2010). Inquiry Report into Gambling. Canberra: Productivity Commission. Purdie, N., Matters, G., Hillman, K., Murphy, M., Ozolins, C., & Millwood, P. (2011). Gambling and young people in Australia. Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International journal of behavioral medicine, 15(3), Suomi, A., Jackson, A. C., Dowling, N. A., Lavis, T., Patford, J., Thomas, S.,... Cockman, S. (2013). Problem gambling and family violence: family member reports of prevalence, family impacts and family coping. Asian Journal of Gambling Issues and Public Health, 3(13), Thomas, S. L. (2012). Conceptualisations of gambling risks and benefits: A socio-cultural study of 100 Victorian gamblers. Report for the Victorian Department of Justice. Tolchard, B., & Battersby, M. W. (2010). The Victorian Gambling screen: reliability and validation in a clinical population. Journal of Gambling Studies, 26(4), Williams, R. J., & Volberg, R. A. (2012). Developing a short form of the PGSI: report to the Gambling Commission. Gambling Commission. CVPCP Building Youth Resilience against Problem Gambling 38

39 CVHA Problem Gambling Literature Review Gambling Gambling is a common recreational activity in Australia with about 70% of adults participating in some form of gambling each year (Thomas & Lewis, 2011, pp.1). Gambling can be described as the placing of a wager or bet in the form of money or something of value on the outcome of an uncertain event that may involve the elements of skill and chance (Jackson, 2006, pp.8). Purdie et al (2011, pp.4) defines three forms of formal gambling activities in Australia; gaming, in which an item of value is exchanged depending on the outcome of a game, such as card games, roulette or electronic gaming machines (EGMs); betting or wagering, where wagers are placed on the outcome of a race, sporting event or other contest; and lotteries, in which money or prizes are distributed according to a random draw. Of those adults who do gamble, approximately one third does so using EGMs (Purdie et al, 2001, pp.8). There has been a rapid change to the way in which Victorians can gamble in the past two decades the new world of gambling is oriented around continuous and rapid mass consumption focused primarily upon individuals betting in increasingly socially dislocated environments (Adams, Raeburn & de Silva, 2009, pp.688). Also more recently the delivery of gambling has diversified to include online gambling through mobile phones, interactive televisions and the internet including social networking sites. To date research indicates that online gambling is only a small part of overall gambling activities, however it is one of the fastest growing sectors and may be more attractive to young gamblers as they are often the first to adopt new technologies (Thomas & Lewis, 2011, pp.1, Lavoie, & Ladouceur, 2004, pp.24). Gambling has long been a popular social pastime for many Australians, with games of two-up on Anzac Day, sweeps during the horse racing season and footy tipping competitions all socially accepted as part of our typical Australian Culture (Purdie et al, 2001, pp.4).the Australasian Gaming Council (Thomas & Lewis, 2011, pp.1) reported that Australians on the whole perceive that gambling is a relatively harmless form of entertainment for most people. The perceived benefits of engaging in gambling activities have been described by Victorian adults to be winning money (53%), entertainment (32%) and social reasons (30%) (Department of Justice, 2009). There are also financial benefits for gambling venues and governments with the total revenue from gambling in Australia in 2008/9 being $19 billion (Thomas & Lewis, 2011, pp.1). Despite this it is widely acknowledged that gambling also causes harm to some individuals and communities (Thomas & Lewis, 2011; Jackson, 2006; Adams, Raeburn & de Silva, 2009; Rennie, 2009). This has resulted in problem gambling being seen as an important public health concern. Recent public debate, especially within CVHA s catchment area, has highlighted the concern around the negative social consequences of gambling on communities and individuals (EPIC, 2012). Problem Gambling The Victorian Government has adopted the national definition of problem gambling and harm, which proposes that: Problem gambling is characterised by difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community (Neal, Delfabbro, & O Neil, 2005, pp.125). Defining problem gambling this way highlights the underlying condition, the signs and the consequences of problem gambling (Jackson, 2006). There has been some conjecture as to whether problem gambling should be defined based on symptoms rather than presence of harm (Blaszyczynski, 2002). The presence of harm is generally identified based on subjective value judgements, which has been criticised as it may increase the potential for people to be identified as problem gamblers or alternatively at risk. This approach may 1

40 however be beneficial when viewing problem gambling from an early intervention and public health perspective as problem gamblers may be identified at earlier stages. Figure 1 shows the ways in which harm from problem gambling can impact on the individual, their community and society as a whole. Figure 1 Levels of Harm (Rennie, 2009, pp.3) International research has placed the prevalence of problem gambling at % (Thomas and Lewis, 2011, pp.1). In Australia, the Productivity Commission (2010) has estimated that the prevalence of problem gambling among adults is between 0.5 1%, however they also suggest that a further % of adults are at an increased risk of facing problems with their gambling. Victorian data shows that 0.7% of adults are problem gamblers, with 2.4% at moderate risk and 5.7% being low risk gamblers (Department of Justice, 2009). This study also found that problem gambling is higher amongst males, and that there is a higher proportion of moderate risk gamblers in the year old group than in other age groups. Electronic gaming machines (EGM s) have been found to be the most common gambling activity for problem gamblers, however problem gamblers tend to participate in a larger number of different gambling activities compared with non-problem gamblers (Department of Justice, 2009). Problem gamblers were also more likely to gamble alone compared with gamblers in other risk categories (Department of Justice, 2011). The development of problem gambling occurs via a complex set of interconnected factors, causes and determinants. McLeroy et al (1988, cited in Messerlian, 2005) proposed an ecological health promotion model that emphasises the different levels of influence on gambling behaviour, from intrapersonal, interpersonal, institutional, community and public policy domains. (see fig 2) Levels Intrapersonal Interpersonal Institutional Factors Individual characteristics: knowledge, attitudes, beliefs, skills and personality traits. Social networks and support systems: family and peers that provide social identity, support, and role definition. Social institutions with formal/informal rules, regulations, policies that constrain or promote behaviour. 2

41 Community Public Policy Relationships, standards and networks that exist among individuals, groups and institutions. Local, state, federal policies and laws that regulate, support, or constrain healthy actions and practices. Figure 2: Levels of influence on gambling behaviour (McLeroy, 1988; cited in Messerlian, 2005, pp.71) Victorian problem gamblers have more reported health problems, with self-reported general health described as poor in 17% of problem gamblers compared with 3.43% of non-problem gamblers (Hare, 2009). The same study indicated that people with a gambling problem reported: a slightly higher rate of diabetes a significantly higher rate of lung conditions including asthma a significantly higher rate of depression a significantly higher rate of anxiety disorders a significantly higher rate of obesity a significantly higher rate of other miscellaneous physical or mental health conditions. (Hare, 2009, cited in Department of Justice, 2001a, pp.10) The social determinants of health that are related to problem gambling and would have an impact on the above health conditions are: Social exclusion: Problem gamblers have significantly lower social capital than non-problem gamblers, which is indicated by being more likely to not have access to help from friends when they need it, lower rates of participation in organised groups, and being more likely to report not liking living in their community (Hare, 2009, cited in Department of Justice, 2011a, pp.13) Addiction to smoking, alcohol and other drugs: Problem gambling is linked to an increased risk of high alcohol and tobacco use (Hare, 2009, cited in Department of Justice, 2011a, pp.13). Stress: Problem gambling is associated with stress and anxiety and compared to non-problem gamblers, people with a gambling problem were significantly more likely to have a severe or moderate mental disorder (Hare, 2009, cited in Department of Justice, 2011a, pp.13). Social supports: Family and friends of people with a gambling problem are affected both physically and emotionally. 10% of gamblers receiving counselling reported that their gambling had led to incidences of family violence (Productivity Commission, 1999). Children of people with a gambling problem are two to four times more likely to develop gambling problems than their peers (Dowling, Jackson, Thomas, & Frydenberg, 2010, pp.36). There may also be other possible factors at a local level including; financial hardship impacting on food security; insufficient access to public transport leading to social exclusion or lack of access to alternate leisure activities; and unemployment leading to financial stress and reduced social supports (Department of Justice, 2011a, pp.14). Past experiences, exposures and life events are also thought to have an impact on levels of problem gambling, with childhood exposure to gambling, negative childhood experiences and stressful life events influencing behaviours (Hodgins, Stea & Grant, 2011). This is highlighted by the fact that problem gamblers are more likely to report gambling to take their mind off things, to relieve stress and to relieve boredom (Thomas, 2011, pp.5). As mentioned earlier, many forms of gambling have become a typical part of the Australian way of life. Gamblers beliefs and behaviours around their gambling are influenced by the broader society and its social and cultural norms, traditions and values. Recent research has looked at how the changes to marketing of gambling activities have impacted on these beliefs and behaviours. These have also 3

42 been influenced by the large diversity of gambling products now available and accessible through Internet, mobile phones and social media (Productivity Commission, 2010). Local Demographics of the Problem Socio-Economic Demographics Employment: Of those aged 15 years or older 61% in Central Goldfields, 73.1% in Macedon Ranges and 65.7% in Mount Alexander were employed compared to the Victorian State average of 71%. Income levels: Median household income across CVHA s catchment is $685 Central Goldfields, $1,395 for Macedon Ranges and $838 for Mount Alexander. Both Central Goldfields and Mount Alexander fall below the state median household income of $1,216. Education: The percentage of the population aged 15 years and over that had completed year 12 or equivalent was 32.3% in Central Goldfields, 53.2% in Macedon Ranges and 58.2% in Mount Alexander, which are all below the state average of 58.2%. Gambling Statistics In 2011/2012, just over $20.6 million was lost in Electronic Gaming Machines (EGM) in CVHA s three shire areas. However, this money was not lost evenly across the Region. Even accounting for their size and population, some shire areas lost significantly more money than others. The Shire of Macedon Ranges was the biggest loser in terms of total losses ($9.5 million), however the Shire of Central Goldfields had by far the highest EGM spending per adult ($777). The Shire of Mount Alexander experienced the smallest total expenditure (3.2 million) and the lowest expenditure per adult ($217). Accessibility of EGM s in each shire area may explain some of this data. Central Goldfields has a total of 96 EGM s over 2 venues and as such have a high density of EGM s (9.4 per 1000 adults). Macedon Ranges has a total of 95 EGM s at 3 venues but with their larger population this results in a density of 2.9 EGM s per 1000 adults. Mount Alexander has only 30 EGM s at one venue, which translates to 2.04 machines per 1000 adults. This data cannot account for total losses that come from residents within each shire; there is anecdotal evidence of people travelling from one shire area to another to partake in EGM activities. This may in part account for the very high Net EGM expenditure per adults seen in Central Goldfields Shire. Young People and Problem Gambling Many of the more recent changes to gambling culture and products in Australia, including the way that gambling is marketed and its accessibility, especially through internet and smartphones, may influence the behaviours of younger people beyond those of the adult population as they are more connected to the digital world and are generally early adopters of new technologies (Lavoie & Ladouceur, 2004). Studies on young people and gambling tend to focus on the adolescent or school age group, particularly those under the age of 18 as they are not able to legally gamble in Australia, and this appears to be a key stage where gambling behaviours and beliefs are formulated (Purdie, Matters, Hillman, Murphy, Ozolins, & Millwood, 2011). Based on research both internationally and within Australia, despite gambling being illegal for those under the age of 18, anywhere from 50-80% of this age group had gambled in the past year (Volberg, Gupta, Griffiths, Ólason & Delfabbro, 2011). In Australia, studies have identified that the most popular forms of gambling for young people are 4

43 lotteries, scratch-tickets, racing/sports betting, and private card games, and fewer young Australians report using EGM s, which may be due to the majority of subjects being under the age of 18 (Purdie et al., 2011). The prevalence of problem gambling amongst young people has been found to be higher than that in the adult population, with both international and local research finding that 5-7% of young people are problem gamblers and a further 10-14% are at risk or have the potential to become problem gamblers (Purdie et al, 2011; Valentine, 2008; Jackson, 2006). Purdie (2011, pp.61) focussed on people in the year old age group and found they had a higher prevalence of problem gambling (5.8%) compared with younger age groups and a much higher level of at-risk gambling (24.5%). In addition to this they found that Indigenous young people were 6.4 times more likely to be problem gamblers than non-indigenous young people. Messerlian, Derevensky, & Gupta (2005) has adapted McLeroy s (1988, cited in Messerlian et al, 2005) level s of influence on gambling behaviour, in order to present some of the correlates that influence youth gambling at each level, including intrapersonal, interpersonal, institutional, community and public policy (see fig 3). I will go further into some of these correlates next. Levels Factors Youth gambling examples Intrapersonal Individual characteristics: knowledge, attitudes, beliefs, skills and personality traits. Male Risk-taking propensity Low self-esteem Poor coping skills Impulsivity, sensation seeking Interpersonal Institutional Community Public Policy Social networks and support systems: family and peers that provide social identity, support, and role definition. Social institutions with formal/informal rules, regulations, policies that constrain or promote behaviour. Relationships, standards and networks that exist among individuals, groups and institutions. Local, state, federal policies and laws that regulate, support, or constrain healthy actions and practices. Anxiety and/or depression Family history of gambling Parental or peer conflict Parental or peer attitudes Family connectedness School policy/programmes Industry policies and enforcement Social norms Media Community resources Availability and accessibility factors Federal and state policies on: age restrictions, enforcement, advertising, legislation Figure 3 Levels of influence on gambling behaviour (Messerlian et al, 2005 pp.71; McLeroy et al 1988) Intrapersonal factors: There is substantial evidence that gambling and problem gambling are more prevalent amongst young males, in fact problem gambling is at least twice as common in males as females (Purdie et al., 2011, pp.16). Research has suggested that the increased prevalence of male problem gambling may be mediated through other risk factors, for example young males appear to be more prone to risk-taking behaviours in general compared with females, and seem to hold more positive attitudes towards risktaking in relation to gambling (Purdie et al., 2011; Delfabbro, Lahn, & Grabosky, 2006). There are some personality traits that have been found to be more common in problem gamblers. Young problem gamblers tend to have high levels of impulsivity, extroversion and anxiety, while they also report higher rates of a range of mental health and emotional problems (including depression and suicide ideation and attempts), lower self-confidence and self-esteem (Purdie et al, 2006, pp.17). 5

44 Young people with gambling problems also tend to display poorer coping skills (Purdie et al., 2006, pp.18), utilising avoidance or distraction oriented coping strategies. Young people without gambling problems indicate that their reasons for gambling are for enjoyment and excitement, however those with gambling problems are more likely to identify that they gamble to relax, escape problems and alleviate feelings of depression (Derevensky and Gupta, 2004). Many researchers have found that there is a link between problem gambling in young people and an increased risk of other unfavourable behaviours, in particular alcohol and substance abuse (Derevensky & Gupta, 2004). Another factor that has been identified as influencing gambling behaviours is individuals holding misconceptions about the notions of chance and randomness (Lavoie & Ladouceur, 2004). These errors lead gamblers to believe that they have more control over the outcome of the game. Given that the average age that problem gamblers had their first contact with gambling is 10 years old Valentine, 2008), their gambling behaviours and beliefs are formed at a time when they are less able to understand these complex notions. Interpersonal Factors Having a family history of problem gambling, is one of the key risk factors for youth gambling, in fact many problem gamblers report that their initial gambling experiences occurred with family members (Gupta & Derevensky, 1997). Parental problem gambling is thought to affect the gambling behaviours of their children through; observation of parental gambling, exposure to gambling role models (including parent s, parent s friends, other relatives), increased access to gambling opportunities, and peer influence (Dowling, Jackson, Thomas, & Frydenberg, 2010; Delfabbro, Lahn, & Grabosky, 2005). Family structure and functioning can also impact on the risk of problem gambling as youth from singleparent families are at greater risk than others (Volberg et al., 2011, Purdie et al., 2011). The quality of family functioning has been found to play a role, in one study parental practises such as monitoring behaviour and discipline had more of an impact on gambling behaviours than parental gambling behaviours themselves (Vachon, Vitaro, Wanner, & Tremblay, 2004). As well as familial influences on problem gambling, the influence of peers has been found to have an impact, having a friend with a gambling problem had one of the strongest relationships, above all other risk and protective factors, with being a problem gambler (Dickson, Derevensky& Gupta, 2008, cited in Purdie et al., 2011, pp.21). Problem gambling adolescents have also reported poorer relationships with peers and social isolation was found to be a strong predictor of gambling severity (Delfabbro et al, 2006). Environmental Factors (including Institutional and community) The media is an important element that shapes the social environment of youth gambling. The media is saturated with images that normalise and glamorise not just gambling but many risk-taking behaviours, which has a significant influence on young people who spend on average 21 hours per week watching television (Purdie et al, 2011). The Internet and social media, including smart phones, form a part of this social environment and will be discussed later. Institutional structures including regulations and policies of gambling venues can impact on gambling behaviours (Messerlian et al., 2005). As can the accessibility of gambling products, this as mentioned has proliferated recently. However there is little evidence as to whether the opportunity to gamble attracts young people to venues or whether the venues provide a convenient place to hang out in the absence of alternatives (Valentine, 2008). 6

45 Other community institutions can have a significant impact on gambling behaviours and the normalisation of gambling in young people, in particular schools. Some school practices may unknowingly be promoting gambling, including fundraising activities that include raffles, and curriculum activities that include gambling, however they can also be an important vehicle for educating young people about the risks and realities of gambling, in particular the mathematical basis of odds and chance (Messerlian et al., 2005). Public Policy Public policy can control gambling through legislation around age restrictions, advertising and accessibility of gambling products. However governments tend to regulate gambling in a way that promotes the economic benefits, considering governments are highly dependent on revenue from gambling there remains a disincentive to tackle gambling problems form a population health/health promotion perspective (Messerlian et al., 2005, pp.72). The question still remains that given the above influences, what leads some young people to become problem gamblers and not others? Nower and Blaszczynski (2004) have adapted the Pathways Model to identify youth problem gambling pathways. This model proposes that while problem gamblers share many characteristics, there are at least three distinct sub-groups of problem gamblers with different gambling pathways; behaviourally conditioned problem gamblers; emotionally vulnerable problem gamblers; and anti-social impulsivist problem gamblers. Behaviourally conditioned problem gamblers are those that have no pre-existing social and psychological pathologies. They are often achieving well academically but may be shy and often use gambling to facilitate social interactions with peers. They are often able to hide their gambling until they reach a crisis point. Emotionally vulnerable problem gamblers are those that do exhibit preexisting psychological issues such as anxiety or depression, or may be affected by adverse life events. This group tends to gamble as a means of escape from their problems. This group makes up the biggest proportion of problem gamblers. Anti-social impulsivist problem gamblers are those that have a pre-existing history of impulsive behaviour and often exhibit a range of other behavioural problems including substance abuse, sensation seeking and criminal activity. These different pathways then present different opportunities to implement both prevention and early intervention strategies, which will be discussed later. Young people and online gambling The recent growth of online gambling opportunities is of concern for youth problem gambling, as is the insidious way that gambling has become a part of many online gaming and social media activities (Griffith & Parke, 2010). The distinction between online gaming and gambling is being blurred with many gaming sites utilising free gambling within games or providing in game rewards or tokens that can then be used for gambling purposes (Messerlian, Byrne, & Derevensky, 2004). Social networking sites also play a role in the proliferation of gambling opportunities, particularly aimed at young people, for example one of the most popular games on Facebook is Texas Hold em poker (Kinnunen, 2010). Brunelle, Cousineau, Dufour, Gendron & Leclerc (2009) on interviewing young online gamblers found the main types of online gambling activities to be poker, blackjack, electronic gaming machines, bingo and sports betting. This study also found that problem gambling was significantly more likely among Internet gamblers (10%) compared to non-internet gamblers (3%). This may be due to the fact that Internet gamblers, as with problem gamblers, tend to participate in more different gambling forms and gamble more frequently than non-internet gamblers (Gainsbury, Hing, Blaszczynski, & Wood, 2011). 7

46 Ease of accessibility, convenience and greater privacy are characteristics of online gambling that make it increasingly attractive to young gamblers, therefore may lead to the increase of both the presence and severity of problem gambling in young people (Productivity Commission, 2010). The use of credit cards and Internet bank transfer, although convenient, led to an increase in the amount spent in just over half the problem gamblers studies compared with one tenth of non-problem gamblers (Gainsbury et al., 2011). Internet gambling may also act to increase levels of social isolation (Thomas & Lewis, 2012), however Kinnunen (2010) indicates that a large part of online gambling requires interaction between players, and although there are plenty of opportunities to play alone, online gambling in not inherently an asocial activity. Brunelle et al. (2009) looked at the motivations to take part in internet gambling and concluded that most initiation of online gambling took place with family members, most adolescent online gamblers began by playing free play mode and for many adolescents online gambling was a way to make money, occupied them when they had nothing else to do, and allowed them to socialise. Screening and assessment for young people with gambling problems A number of screening tools have been used in youth gambling research, Purdie et al. (2011) has identified and discussed those that have been reviewed for use with young people, particularly in Australian studies: The South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) was developed for use with adolescents between the ages of Researchers have raised concerns that the items focus on the negative feelings and behaviours associated with a young persons gambling but does not include cognitive aspects of their problem gambling (Poulin, 2000; Derevensky and Gupta, 2004). Others have raised concerns that a large proportion of the items were misunderstood by young people and less than a third of participants correctly understand all of the items (Purdie et al., 2011, pp.30). The Diagnostic and Statistical Manual Fourth Edition Adapted for Juveniles (DSM-IV-J) has been adapted to measure the gambling behaviour of year olds over the preceding 12 months. This instrument has been further revised for use in other non-clinical settings and reports demonstrate that it has reasonable levels of reliability and validity (Fisher, 2000). It has also been recommended for future use due to its low reading age, which may help with accuracy of response. The Victorian Gambling Screen (VGS) was commissioned by the Victorian Gaming Authority for use with Australian populations after concerns were raised about the use of the South Oaks Gambling Screen. When tested against the SOGS it was found to be more sensitive to differences in gambling problem severity among those who are problem gamblers (Purdie et al., 2011, pp.35). Although a youth version has yet to be published, it has been used in a study of Australian adolescent gambling and was found to have good reliability and correlated significantly with the DSM-IV-J (Delfabbro et al., 2005). All of these instruments are self-report instruments of behaviour and as such are subject to measurement error. Interestingly, Hardoon, Derevensky & Gupta (2003), found that 3-6% of young people were classified as problem gamblers using three different instruments, however only 1% of young people see themselves this way. Either young people are underestimating their gambling problems or the instruments are overestimating prevalence rates. This could work in the favour of early detection of potential problems. Early intervention and prevention of the development of problem gambling in young people, with a focus on community engagement, social connectedness and increased resilience. 8

47 Public Health interventions targeted at reducing the harm from problem gambling aim to shift from focusing on treating the individual with problems to looking at broader determinants of gambling behaviour by making changes to; consumption environments; the nature of the product; and knowledge and beliefs that influence patterns of gambling (Adams et al., 2009, pp.689). If we think of all youth sitting somewhere along a continuum in relation to problem gambling behaviours, with one end representing non-gamblers and the other end problem gamblers, we start to visualise the points where intervention may have an impact to prevent further harm form occurring. Figure 4 illustrates this continuum and highlights; the points for primary, secondary and tertiary prevention intervention; the prevention objectives at each of these points; and the recommended health promotion strategies required to achieve the prevention objectives (Messerlian et al., 2005, pp.72-73) Figure 4 Youth gambling and risk prevention model (Messerlian et al., (2005) Health Promotion interventions aim to affect change at the primary and secondary prevention stage of youth problem gambling. This review will now focus on the early intervention and prevention strategies of community engagement, social connectedness and increasing resilience. Community engagement, or public participation as it is often referred to, is defined by the International Association of Public Participation as any process that involves the public in problem-solving or decision making and uses the public input to make more informed decisions. This includes decisions that directly impact upon living, working, playing, studying, using services and doing business within the City (Charles Sturt University). Engaging with the community is more than just consulting. Community engagement includes informing, consulting with, involving, collaborating with and empowering the community. Community engagement leads to more active participation of the target group in community life. Community engagement when successful can promote social inclusion and connectedness and increase both community and individual resilience (Charles Sturt University). 9