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Preventing problem gambling: Focus on overconsumption
Stockholm University, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0003-3908-5841
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A proportion of gamblers experience problems. The role of overconsumption in developing gambling problems is sparsely described in the literature and there is little scientific knowledge about the prevention of gambling problems. There are some promising results regarding personalized feedback on gambling habits, and there is a need for more research. The overall aim of this thesis was to explore the role of overconsumption in problem gambling and target it in a preventive intervention. The preventive intervention was to give gambling consumption feedback to high consumers in order to make them reflect upon their gambling habits and enhance their motivation for change. Study I aimed to explore the dimensionality of GamTest, an online test of gambling behaviour, and validate it against PGSI and the gambler’s own perceived problems. Data came from four Nordic gambling sites, n = 10,402. In an ESEM analyses, GamTest had a high degree of correspondence with the players’ own perceived problems and with the PGSI. In an EFA, GamTest captured five dimensions of problematic gambling (i.e. overconsumption of money and time, and negative financial, social and emotional consequences). A bifactor approach showed a general factor and four specific residual factors, negative emotional consequences contribute to the dominant part of the general factor. Study II aimed to examine both the psychometric properties of the Jonsson-Abbot Scale (JAS) and its predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3,818 participants within the Swedish longitudinal gambling study. The results indicate an acceptable fit of a three-factor solution in a CFA, with ‘Overconsumption (OC),’ ‘Gambling fallacies (GF),’ and ‘Reinforcers (RI)’ as factors. When controlled for risk potential measured at baseline, GF and RI were significant predictors of gambling risk potential, and GF and OC were significant predictors of problem gambling onset at 12-month follow up. Study III’s primary objective was to investigate the effects of providing personalized feedback on gambling intensity among high consumers in Norway. An RCT design was used to evaluate how behavioural feedback by telephone or letters affects subsequent gambling expenditure. A sample of 1,003 statistical matched triplets, from the top 0.5 % of customers, were randomly assigned to telephone, letter, or a no-contact control condition. Over 12 weeks, theoretical loss decreased 29 % for the telephone, and 15 % for the letter, conditions, compared with 3 % for the control group. Study IV was a 12-month follow-up of Study III, aimed to investigate the relative effects over twelve months. The telephone group showed a 30 % reduction in theoretical loss, the letter group 13 %, both outperforming the control group with a 7 % reduction. Less than 1% in all groups stopped playing at Norsk Tipping. These four studies indicate that overconsumption of gambling plays different roles in problem gambling. The role of overconsumption in preventing gambling problems is discussed. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty of care for customers. Technical evolution has made it possible for gambling companies to fulfil their duty of care, but this has to be regulated and mandatory if it is to be effective.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University , 2019. , p. 109
Keywords [en]
gambling, problem gambling, prevention, overconsumption, responsible gambling, online self-test, ESEM, psychometric properties, predictive, longitudinal, CFA, gambling fallacies, reinforcers, personalized behavioural feedback, motivational interviewing, gambling expenditure, RCT, 12-month follow-up
Keywords [sv]
spel om pengar, problematiskt spelande, prevention, överkonsumtion, spelansvar, online självtest, ESEM, psykometriska egenskaper, prediktiv, longitudinell, CFA, tankefällor om spel, psykologiska förstärkare, personifierad återkoppling på beteende, motiverande samtal, spelutgifter, RCT, 12-månaders uppföljning
National Category
Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-172446ISBN: 978-91-7797-743-8 (print)ISBN: 978-91-7797-744-5 (electronic)OAI: oai:DiVA.org:su-172446DiVA, id: diva2:1347137
Public defence
2019-10-18, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Submitted.

Available from: 2019-09-25 Created: 2019-08-30 Last updated: 2019-09-16Bibliographically approved
List of papers
1. GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior
Open this publication in new window or tab >>GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior
2017 (English)In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 33, no 2, p. 505-523Article in journal (Refereed) Published
Abstract [en]

Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler's own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players' own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.

Keywords
Gambling, Behavior self-diagnostic test, GamTest, Validation, Exploratory structural equation modeling (ESEM), Online gambling
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-144665 (URN)10.1007/s10899-017-9676-4 (DOI)000402186400012 ()28265831 (PubMedID)
Available from: 2017-07-24 Created: 2017-07-24 Last updated: 2019-09-04Bibliographically approved
2. Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale
Open this publication in new window or tab >>Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale
2017 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 8, article id 1807Article in journal (Refereed) Published
Abstract [en]

Traditionally, gambling and problem gambling research relies on cross-sectional and retrospective designs. This has compromised identification of temporal relationships and causal inference. To overcome these problems a new questionnaire, the Jonsson-Abbott Scale (JAS), was developed and used in a large, prospective, general population study, The Swedish Longitudinal Gambling Study (Swelogs). The JAS has 11 items and seeks to identify early indicators, examine relationships between indicators and assess their capacity to predict future problem progression. The aims of the study were to examine psychometric properties of the JAS (internal consistency and dimensionality) and predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3818 participants. The response rate from the initial baseline wave was 74%. The original sample consisted of a random, stratified selection from the Swedish population register aged between 16 and 84. The results indicate an acceptable fit of a three-factor solution in a confirmatory factor analysis with ‘Over consumption,’ ‘Gambling fallacies,’ and ‘Reinforcers’ as factors. Reinforcers, Over consumption and Gambling fallacies were significant predictors of gambling risk potential and Gambling fallacies and Over consumption were significant predictors of problem gambling onset (incident cases) at 12 month follow up. When controlled for risk potential measured at baseline, the predictor Over consumption was not significant for gambling risk potential at follow up. For incident cases, Gambling fallacies and Over consumption remained significant when controlled for risk potential. Implications of the results for the development of problem gambling, early detection, prevention, and future research are discussed.

Keywords
predictive, reinforcers, over consumption, gambling fallacies, CFA, longitudinal, gambling problem
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-148130 (URN)10.3389/fpsyg.2017.01807 (DOI)000412954400001 ()
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2019-08-30Bibliographically approved
3. Reaching Out to Big Losers: A Randomized Controlled Trial of Brief Motivational Contact Providing Gambling Expenditure Feedback
Open this publication in new window or tab >>Reaching Out to Big Losers: A Randomized Controlled Trial of Brief Motivational Contact Providing Gambling Expenditure Feedback
2019 (English)In: Psychology of Addictive Behaviors, ISSN 0893-164X, E-ISSN 1939-1501, Vol. 33, no 3, p. 179-189Article in journal (Refereed) Published
Abstract [en]

Gambling disorder is a public health issue in many countries, and expectations that the gambling industry protects individuals from harm are increasing. The primary objective of this study was to investigate the effects of providing personalized feedback on gambling intensity among high consumers of venue-based and online gambling in Norway. A randomized controlled trial design was used to evaluate how behavioral feedback by telephone or letters sent via surface mail affects subsequent gambling expenditure and use of responsible gambling tools and whether a follow-up contact increases the effect. Gambling expenditure, the primary outcome, was measured using theoretical loss, which is the actual cost to the player, adjusted for the house advantage. From the top .5% of customers based upon annual expenditure, a sample of 1,003 statistical triplets, matched on sex, age, and net losses, were randomly assigned to the feedback intervention by telephone, letter, or a no-contact control condition. Participants assigned to the phone call or letter were also randomly assigned to receive or not receive a subsequent follow-up contact. The results showed that over 12 weeks, theoretical loss decreased 29% for the phone and 15% for the letter conditions, compared with 3% for the control group. A positive effect of the follow-up contact was limited to participants who at the initial call indicated an interest in receiving a follow-up call. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty to care for customers.

Keywords
behavioral feedback, problem gambling, prevention, responsible gambling, motivational interviewing
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-168705 (URN)10.1037/adb0000447 (DOI)000465625800001 ()
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-08-30Bibliographically approved
4. Reaching out to big losers: Brief motivational contact leads to sustained reductions in gambling over one year
Open this publication in new window or tab >>Reaching out to big losers: Brief motivational contact leads to sustained reductions in gambling over one year
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Background and aims: We previously demonstrated that phone and letter-based motivational interventions with high expenditure gamblers had significant short term positive effects on gambling and use of responsible gambling tools. This report examines outcomes over twelve months.

Design: A randomized controlled trial design with three conditions: feedback intervention by telephone, letter, or a no-contact control condition.

Setting: Customers of Norsk Tipping gambling platforms.

Participants: 1,003 statistical triplets from the top .5% of customers based upon annual expenditure, matched on sex, age, and net losses.

Measurements: Primary outcome measure was gambling theoretical loss, derived from the Norsk Tipping customer database. Secondary outcomes were responsible gambling customer actions and whether the participant was retained as a NT customer.

Findings: The results showed a positive and sustained effect of the phone and letter interventions over 12 months - the telephone group showed a 30% reduction in theoretic loss (d =0.44) and the letter group 13% (d =0.18), both outperforming the control group with a 7% reduction (d =0.11). The phone condition was superior to both the letter and control conditions in per protocol (p<0.001) and intention to treat analyses (ITT) (p< 0.018 and 0.001). Individuals in the phone condition took more responsible gambling actions. The letter condition had better outcomes than the control in the ITT only (p<0.001). Over 99% in the intervention groups were still customers during the follow-up year.

Conclusions: A targeted telephone intervention with high expenditure customers effectively reduced theoretical losses over a 12 month period. Gambling companies can utilize this type of intervention as a response to their duty to care for customers.

Keywords
Behavioral feedback, Motivational intervention, Problem gambling, Prevention, Responsible gambling, long term effect
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-172361 (URN)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-09-04Bibliographically approved

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