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Home/Programs & Services/Gambling from a Public Health Perspective/Products and Tools

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Infographics

Infographics are a visual way of telling a story by displaying data, information, or knowledge through a mix of pictures and words. GREO is developing infographics for events, the Focus On series, and other knowledge translation and exchange projects. We encourage you to use them, and share them via social media and your website.

Gambling from a Public Health Perspective

GREO has been working to reframe gambling harms within the spectrum of harms from substance misuse and mental health, and emphasize the benefits of applying a public health approach to reducing gambling harm.

This infographic was created to map the path steps through which this work has unfolded, as well as the governing principles that drive our work with community health stakeholders in the public health forum.

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Gambling and Adolescents

Gambling is appealing to adolescents and younger adults, as it provides high levels of entertainment and excitement. School is a major environment where children and young adults can gamble. Recently, poker and online gambling have become the preferred gambling activity amongst this demographic. Online gambling provides convenience, anonymity, an alternative reality, and immediate gratification. Parents can play a major role in limiting gambling opportunities. The earlier that children are exposed to gambling, the more risk they have of developing a problem.  

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Reports

Gambling as a Public Health Issue (CAMH)

Health agencies such as the World Health Organization (WHO) do not consider gambling a public health issue, and as a consequence there are no global public health frameworks for gambling. The purpose of this report is to provide a summary of the evidence demonstrating why gambling should be considered a public health issue and how public health can inform gambling strategies using evidence from other domains and jurisdictions. The report includes a scoping review of the literature on the social determinants of health and how they relate to gambling, and explores strategies from existing public health initiatives for tobacco, alcohol, and other substance use that can be applied to gambling. The report also discusses Australia and New Zealand's efforts to approach gambling as a public health issue. The report concludes that an approach to gambling that considers social determinants of health is warranted. It also advocates for adopting strategies that address multiple addictions including gambling, and taking existing successful public health strategies for substance use and adapting them for gambling.

This is the full technical report for this study. A two-page plain-language project summary is also available on the GREO Evidence Centre here.

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Canadian Public Health Association Position Paper on Gambling: An Emerging Public Health Issue

The Canadian Public Health Association's statement on gambling expansion in Canada as an emerging public health issue.

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Applying a Public Health Perspective to Gambling Harm

This report summarizes existing literature examining the relationship between problem gambling and comorbid mental health and substance use disorders, and the prevalence of problem gambling among target demographics that are more susceptible to its associated harms. This report also enphasizes the capacity for a public health framework to enhance and inform the prevention, policies, and treatment for both problem gambling and its associated comorbid disorders.

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Assessing Gambling-Related Harm in Victoria: A Public Health Perspective

The Victorian Responsible Gambling Foundation engaged CQU's Experimental Gambling Research Laboratory to develop a framework and a methodology for understanding and measuring gamblingrelated harm in the Victorian population. The aim of the project was to systematically investigate gambling-related harm in Victoria, and assess the aggregate 'Burden of Harm' caused by gambling in Victoria with reference to different levels of problem gambling, and other comparable conditions. This improved understanding of the quality and quantity of harm will help to better target efforts to prevent or reduce the potential negative consequences of problematic gambling.

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Best practice in problem gambling services

A range of different treatment programs available to problem gamblers, both within Australia and overseas, were reviewed in order to develop an understanding of best practice service models in the field. The organisational structure, theoretical orientation and the treatment approach and techniques used were examined with an emphasis primarily on describing sites of intervention and to a lesser extent, forms of intervention. This review was undertaken from an explicit starting point -- that there are no internationally established models of best practice in problem gambling services in existence.

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The relationship of ecological and geographic factors to gambling behavior and pathology

The current study examined the effect of neighborhood disadvantage and gambling availability on gambling participation and pathology. A national telephone survey included 2631 US adults. Census data was used to characterize the respondent's neighborhood, and the distance from the respondent's home to gambling facilities was calculated. Logistic and linear regressions were performed to predict gambling participation and pathology. Results showed that the neighborhood disadvantage was positively related to frequency of gambling and problem/pathological gambling. The presence of a casino within 10 miles of the respondent's home was positively related to problem/pathological gambling. The permissiveness of gambling laws was positively related to any gambling in the past year, as well as frequent gambling. These results were interpreted to mean that the ecology of disadvantaged neighborhoods promotes gambling pathology, and that availability of gambling opportunities promotes gambling participation and pathology.

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Toronto Public Health Position Statement: Gambling and Health

In response to a proposed local casino development in 2012, Toronto Public Health published a position statement on the health impacts of gambling, in the context of overall gambling expansion in Ontario. Gambling expansion has been identified as a significant public health issue across Canada in the previous two decades, mainly due to the overlapping harms between gambling and coexisting substance misuse and mental health problems.

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The Health Impacts of Gambling Expansion in Toronto: Technical Report (November 2012)

This report outlines the key issues and current research on the public health impacts of gambling. Hosting a new casino in Toronto is anticipated to increase the frequency and severity of problem gambling in the city, which can produce negative health impacts on individuals, families and communities. This report discusses the public health implications of casino expansion in Toronto, and was published by Toronto Public Health in collaboration with CAMH in response to a proposed casino development in 2012 in the Toronto area. It calls for ongoing and thorough monitoring of the health, social and economic impacts of casino development, and places emphasis on applying the public health approach to generate interventions that prevent or mitigate gambling-related harm, promote healthy choices, and protect at-risk populations.

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Research Snapshots

GREO has partnered with Research Impact to develop our Research Snapshots - plain language summaries of gambling and problem gambling literature, and the comorbid disorders and determinants of gambling harm. In these snapshots, we provide a succinct review of strong peer-reviewed journal articles, to make this knowledge more accessible and to enable its use in evidence-based decision making and future research.

All of our Research Snapshots are written by trained plain language writers and are approved by the author of the original academic article.

Gambling as a public health issue

Here are a few Research Snapshots that explore gambling harms from a public health perspective. An applied, systems-focused approach that aims to prevent gambling harm, protect vulnerable or at risk groups, and address systemic health inequities, is a core component of addressing harms from gambling at the population level. To learn more, visit our Evidence Centre by clicking the link below.  

Search Gambling and Public Health
Does casino availability impact participation in gambling and problem gambling risk levels? 

The relationship between the number of casinos in an area and gambling problems is unknown. The current study merged a large and representative health data set with casino location data to estimate the relationship. An increased number of casinos in an area was related to increases in both gambling participation and problem gambling risk. Hospitality and tourism planners could consider increased investment in responsible and problem gambling programs when expanding gambling venues in an area. 

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Why a population approach may be needed to prevent gambling-related harms

Public health typically uses two different approaches for the prevention of addictions. High-risk approaches target small groups of individuals who are at high-risk for an addiction. Population approaches focus on the general population as a whole to decrease overall problems. Population approaches may be necessary due to the “prevention paradox”. The “prevention paradox” occurs when individuals who are at low- or moderate-risk for an addiction account for most problems in the society. This is simply because there are more individuals within this group, and only a small number of individuals are at high-risk. In alcohol addiction, although heavy drinkers experience more harms from drinking, low-risk drinkers account for most problems because of the greater number of low-risk drinkers. The current study examined whether the “prevention paradox” applies to gambling-related harms in the British context.  

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How much harm do gambling problems cause on quality of life?

Researchers often use the Problem Gambling Severity Index (PGSI) to measure gambling problems in a community or population. However, different groups may experience different harms from gambling. The PGSI captures symptoms of problem gambling on an individual basis based on the person’s gambling behaviours. It cannot determine the degree of harms experienced by individuals with different levels of problem gambling (e.g., low-risk versus problem gambling). Also, the PGSI does not allow for the harms that gambling causes to be compared to the harms resulting from other health conditions. 

The current study determined how much a typical person is harmed, given their level of problem gambling. To do this, it related problem gambling severity based on the PGSI to health-related quality of life (HRQoL). HRQoL refers to an individual’s or group’s physical and mental health over time. Also, the current study compared the impacts on quality of life caused by gambling to the impacts caused by other health conditions.

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A tool to screen and monitor the population-level impact of gambling harms
The current study developed a short screen for gambling harms, with the goal of being used at a population-level. Analyses found that the Short Gambling Harm Screen (SGHS) discriminated participants experiencing lower and higher degrees of harm. It corresponded to other assessments on gambling problems and well-being. For instance, participants who endorsed more harms on the SGHS had poorer wellbeing. Further, it could be used across gender and age groups. The researchers concluded that the SGHS is a valid scale for measuring the population-level impact of gambling harms.The current study developed a short screen for gambling harms, with the goal of being used at a population-level. Analyses found that the Short Gambling Harm Screen (SGHS) discriminated participants experiencing lower and higher degrees of harm. It corresponded to other assessments on gambling problems and well-being. For instance, participants who endorsed more harms on the SGHS had poorer wellbeing. Further, it could be used across gender and age groups. The researchers concluded that the SGHS is a valid scale for measuring the population-level impact of gambling harms.
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Defining and categorizing gambling-related harms
Gambling can negatively impact individuals, families, and communities. Public health interventions to prevent or treat gambling problems often focus on reducing harm caused by gambling. However, there is no consistent definition of gambling-related harm for public health to use. There is also no conceptual framework that captures the diverse types of harm due to gambling. A conceptual framework is a network of linked ideas that help to explain a topic, such as problem gambling. The lack of consistent definition and conceptual framework causes difficulties for public health in addressing gambling-related harm. Thus, the current study proposed a definition and conceptual framework of gambling-related harm. The framework identifies and classifies the diverse types of harm that may be experienced by gamblers, affected others, and the broader community. 
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Problem gambling in the UK: a public health issue affecting individuals, families, and communities
This study examined the links between problem gambling and the physical, mental and social well-being of adult gamblers in the United Kingdom (U.K.). Data were drawn from the 2007 Adult Psychiatric Morbidity Survey, a randomly selected sample of over 7000 adults. Researchers have identified an increase in problem gambling in the U.K. but its implications for individuals, families and communities are unknown. The term ‘problem gambling’ refers to gambling causing a wide range of harms from moderate to extreme. Rates of disordered gambling are below 1% in England.  However, more people are reported as being ‘at-risk’ of problem gambling. ‘At-risk’ refers to gamblers who have already experienced some harm from gambling and remain vulnerable.
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Substance use and gambling in adolescents

Gambling, in different forms, has become an increasingly popular and prevalent behaviour among adolescents and young adults. As the gambling landscape continues to evolve, these forms of entertainment are becoming increasingly diverse, and more accessible to this demographic. As with substance use, early exposure to gambling is a significant predictor of future challenges with problematic behaviour. 

Here are a few Research Snapshots that explore the complex relationships between substance use and gambling behaviour among adolescents and young adults, and how these relationships can influence the harms from gambling in this demographic. To learn more, visit our Evidence Centre by clicking the link below.

Search Gambling, Substance Use and Adolescents
The impact of marijuana use and problem gambling on adolescents

Many people gamble for fun and entertainment. However, some individuals lose control and develop problem gambling. These individuals continue to gamble even though gambling has caused them significant harm, such as debts and family conflicts. Others have less severe patterns of gambling and are considered to be at-risk gamblers. Adolescents and young adults are more likely to be at-risk or problem gamblers compared to older adults. Marijuana use commonly co-occurs with gambling and may have an impact on gambling behaviours. Thus, this study examined how marijuana use might influence the severity of gambling and a range of health and social functioning in adolescents.

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Adolescent problem gambling is associated with alcohol and substance use, psychological distress, suicide attempts, and delinquent behaviours

Research has shown that problem gambling among adolescents is associated with many risk factors, including alcohol and substance use. However, the link between adolescent problem gambling and these risk factors is often examined in separate theoretical frameworks. Research with representative and population-based samples is also lacking. This study analyzed data from the 2009 Ontario Student Drug Use and Health Survey to examine the link between adolescent problem gambling and known risk factors as part of a broad theoretical framework.

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Problem Gambling impairs decision-making skills of youth

Past research has identified several factors that play a role in youth problem gambling. First, youth are still in their developmental stage and do not have a fully matured brain. As a result, youth have poorer decision-making skills compared to adults. Cognitive distortions also play a role in youth problem gambling. Cognitive distortions are irrational beliefs about gambling. They include believing that one can influence or predict the outcome of a game that is determined by chance. Moreover, problem gambling in youth is often linked to other risky behaviours, including alcohol and substance abuse. The current study investigated the impact of gambling involvement on youth decision-making. It also examined for differences in irrational beliefs and alcohol use between youth problem gamblers and non-problem gamblers. Finally, it assessed if decision-making, irrational beliefs, and alcohol use could predict youth problem gambling.

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Gambling and socioeconomic status

Gambling harm is experienced disproportionately throughout the population. Income plays a significant role in how different people engage in gambling and experience the harms from this activity. 

Here are a few Research Snapshots that explore the role of income in gambling harm and problem gambling behaviour. To learn more about gambling, income, and socioeconomic status, visit our Evidence Centre by clicking the link below.

Search Gambling and Socioeconomic Status
 
Risk of problem gambling is greater for adolescents living in areas with higher income inequality

Problem gambling has a social and geographical gradient. That is, problem gamblers are more likely to live in disadvantaged areas, be unemployed and have lower income. People who face income inequality are more likely to take risks, including gambling in the hope of escaping poverty. They may believe that they cannot reach what they desire (e.g., money, status) via conventional means (e.g., a job). Thus, gambling is seen as a way to gain money. The stress of living in poor conditions can also drive people to gamble to cope with negative moods. To date, no studies have investigated the link between income inequality and problem gambling in adolescents. 

On the other hand, social support may protect adolescents against problem gambling. A few studies have found that adolescents without a gambling problem have more support from parents and friends than those who are at-risk or problem gamblers. Support from teachers can also lower the likelihood of engaging in gambling activities. 

The main aim of this study was to examine if Italian adolescents living in regions with higher income inequality would be more likely to gamble problematically. Another aim was to examine if perceived social support would protect adolescents from problem gambling. Perceived social support was the extent of support the adolescents believed they had from families, friends, teachers, and classmates. 

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Social inequality affects the relationship between poor mental health and gambling problems

Over the last 20 years, there has been a significant increase in the number of gambling venues in Canada as well as in other countries around the world. In Ontario, Canada, gambling opportunities are prevalent in communities that have low socio-economic status - that is, poor areas with lower education and lower income. Easy access to gambling opportunities can lead to more gambling problems. Individuals with gambling problems are also more likely to have mental health problems, such as mood and anxiety disorders. Mental health problems are more common among people with low socio-economic status. The researcher investigated how the relationship between problem gambling and mood and anxiety disorders might be affected by socio-economic status. There have been no studies to date that examine the link between these three factors.

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Gambling expenditure in relation to net income among Finnish men and women

Gambling expenditure (GE) is the total amount of money that gamblers spend or lose. Finland has one of the highest rates of GE per capita in Europe. Past research has found that greater GE is related to gambling harms. It is important to know the breakdown of GE by individuals in different population groups to know where to target harm prevention efforts. For example, population groups may include people from different age groups, from different socio-economic backgrounds, and individuals with gambling problems. The current study investigated GE and its relationship with socio-demographics, health-related factors, and past-year gambling behaviours among Finnish men and women.

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Gambling and Ethnicity

While often there are many other physical, sociocultural and economic determinants at play, a person's ethnicity can shape their experience with gambling harm. As people of different ethnicities engage with gambling as a form of entertainment in different ways, so too do they experience the harms from gambling differently.

Here are a few Research Snapshots that explore the complex role of ethnicity in gambling behaviour, and the distribution of gambling harm. To learn more, visit our Evidence Centre by clicking the link below.

Search Gambling and Ethnicity
Canadian Aboriginals have similar gambling attitudes and behaviour as non-Aboriginals

Gambling was an important part of North American Aboriginal culture and tradition. Historically, Aboriginal groups believed that supernatural spirits could influence the outcomes of events. Thus, the outcomes of gambling games were sometimes used to foresee future events. Aboriginals believed gambling brought spirits together. As a result, gambling games were an important part of traditional ceremonies that were performed to make sure a hunt would go well, to ask for rain, or to cure sickness. Gambling was also part of Aboriginal politics and allowed tribes to compete in contests. Gambling games gave Aboriginal groups an opportunity to trade and be social. Games were found to be similar across Aboriginal tribes in North America, which suggests that gambling was valuable for tribal interaction.

In contrast, gambling in North America today is used to make profits and entertain people. It does not have the spiritual and ceremonial purpose it had in Aboriginal culture. It is not known how the change in purpose has affected North American Aboriginal groups. The research team explored the attitudes, motivations, and gambling behaviour of Aboriginals who lived in cities in Alberta, Saskatchewan, and Manitoba. Aboriginals in this study were people who identified themselves as being either First Nations, Métis, or Inuit. First Nations was used in the study to mean a reserve community or band.

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Social risk factors predict problem gambling in urban Canadian Aboriginals

Previous research has shown that North American Aboriginals have higher rates of gambling than the general populations. Aboriginals also have higher rates problem gambling. However, little research has been done on urban Aboriginal populations. In recent years, many Aboriginals in Canada have moved to live in urban cities. The aim of this study was to survey a group of urban Canadian Aboriginals to determine the prevalence of gambling and problem gambling. The researchers also explored factors that contributed to gambling and problem gambling in this population. Participants were from 15 cities in the provinces of Alberta, Manitoba and Saskatchewan. Legal gambling opportunities are widely available in these cities. Forms of gambling include lotteries, sports betting, bingo, electronic gambling machines, and casino. 

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Social and cultural factors impact problem gambling in various racial/ethnic groups

Gambling exists in various forms in almost every culture. In many cultures, gambling is viewed as a common pastime. However, the possibility of developing problem gambling (PG) exists regardless of a gambler's racial/ethnic background. Little research has examined the role of culture in the development and maintenance of PG. Thus, the current review investigated the impact that race, ethnicity, cultural beliefs, and social factors (i.e., income or education) have on PG. The researchers presented their review of gambling research studies with five racial/ethnic groups, including Black, American Indian/Aboriginal, Asian, Latino/Hispanic, and White American populations. The current review also provided practical suggestions for treating PG in diverse cultural groups. 

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What are the effects of age and ethnicity on gambling motivations and gambling disorder? 

Past research shows that ethnicity and age are two risk factors for gambling disorder. Non-Caucasians have been shown to be at greater risk of gambling disorder than Caucasians. Also, young adults are at greater risk than older people. However, limited research has been done to investigate how ethnicity and age may interact in regards to gambling disorder. 

Gambling motivations may also influence the development of gambling disorder. Individuals may gamble to escape or avoid stress in their everyday lives. However, individuals may also gamble for positive reasons, such as winning money. Past research has found that those who gamble as an escape are at greater risk of gambling disorder than those who gamble for positive reasons. The current study examined how age and ethnicity might interact to contribute to the development of gambling disorder. It also explored if gambling motivations (e.g., gambling as an escape) might vary across different ethnic and age groups.

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Risk factors for problem gambling among different ethnic groups in New Jersey, USA
This study investigated gambling behaviour and risk factors for problem gambling among different ethnic groups in New Jersey, USA. Participants were 2173 adults who had gambled at least once in the past year. In contrast to previous research, this study found that Hispanics were more likely than other ethnic groups to be problem gamblers, to have substance addictions, and to report mental health problems. Whites were more likely to be non-problem gamblers. Among ethnic minorities as a group, factors that increased the risk of problem gambling included gambling frequently, having friends or family who gambled, and gambling online only. Among Whites, factors that increased the risk of problem gambling included being male, gambling frequently, being addicted to drugs or alcohol, gambling both online and in land-based venues, and playing instant scratch tickets. More research is needed to understand risk factors associated with problem gambling in different ethnic groups.
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Gambling and mental health

Gambling can affect a person's mental health and wellbeing. There are no visible signs or physical changes that a person is struggle with problematic gambling behaviour, or is experiencing the harms from gambling. But, just as substance misuse and poor mental health often co-exist, problem gamblers are more likely than others to suffer from low self-esteem, mood disorders, stress, and anxiety disorders. 

Here are a few Research Snapshots that explore the role of mental health and wellbeing in gambling behaviour, and the distribution of gambling harm. To learn more, visit our Evidence Centre by clicking the link below.

Search Gambling and mental health
Social inequality affects the relationship between poor mental health and gambling problems

Over the last 20 years, there has been a significant increase in the number of gambling venues in Canada as well as in other countries around the world. In Ontario, Canada, gambling opportunities are prevalent in communities that have low socio-economic status - that is, poor areas with lower education and lower income. Easy access to gambling opportunities can lead to more gambling problems. Individuals with gambling problems are also more likely to have mental health problems, such as mood and anxiety disorders. Mental health problems are more common among people with low socio-economic status. The researcher investigated how the relationship between problem gambling and mood and anxiety disorders might be affected by socio-economic status. There have been no studies to date that examine the link between these three factors.

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Exploring the link between anxiety and gambling behaviour in non-treatment seeking gamblers

Gambling disorder is often linked with other mental health issues. These include depression, anxiety disorders, substance use disorders, and suicide risk. Subsyndromal gambling involves significant gambling activity, but does not yet meet the clinical diagnosis of gambling disorder. Subsyndromal gamblers also suffer from similar mental health problems. Previous research has suggested that anxiety can influence gambling behaviour. This study assessed the link between anxiety symptoms, gambling severity, and other cognitive and clinical factors in non-treatment seeking gamblers. 

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Gambling Harms Mind Map

There are a number of physical, sociocultural, economic and environmental determinants that influence the distribution of gambling harm in the population. Similarly to a person's experience with substance misuse, or their struggle with mental health issues, the severity and prevalence of gambling harm depends on these population health determinants - the conditions in which Canadians are born, grow, live, work, and age.

Want to learn more about how the outcomes addressed through your work may overlap with gambling harm? Check out our Gambling Harms Mind Map. 

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Presentations

Through different venues and with a range of audiences, GREO's presentations have spanned a variety of topics and are a key means of sharing our work with our stakeholders. Scroll through a sample of our work below.

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Title of Presentation

Event

Link to Presentation PDF

Public Health Approach to Gambling Theory and Practice: Part 1 Public Health Webinar - Theory and Practice Part 1

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Public Health Approach to Gambling Theory and Practice: Part 2 Public Health Webinar - Theory and Practice Part 2

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Collaborative Gambling Harm Reduction Plan Development and Implementation North Bay BET Webinar Presentation

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Reducing Harms from Gambling through Community Engagement 

Ottawa BET Webinar Presentation

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Stress Lessons:A Mental Illness and Addictive Disorders Prevention Program for Grade 7 Students

WDG BET Webinar Presentation

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Gambling from a Public Health Perspective Gambling Addiction: Science, Independence, Transparency (4th International Symposium, Fribourg, Switzerland)

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Gambling Harm from a Public Health Perspective Health Promotion Ontario, 2017

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Youth gambling: Current issues

Think Tank 2015 on Gambling Research, Policy, and Practice

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Indigenous Issues Related to Casinos and Gambling

Think Tank 2015 on Gambling Research, Policy, and Practice

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Research into Action

Think Tank 2015 on Gambling Research, Policy, and Practice

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Prevention and Minimising Gambling Harm: Moving Research into Action

Think Tank 2015 on Gambling Research, Policy, and Practice

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Women and Gambling

Think Tank 2015 on Gambling Research, Policy, and Practice

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How to Leverage Research Evidence and KTE to Influence Policy and Practice

 

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Fundamentals of Knowledge Translation and Exchange

KTE Student Workshop Series Part I

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Skills and Ideas for #ProblemGambling KTE

KTE Student Workshop Series Part II

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Evaluating Problem Gambling KTE

KTE Student Workshop Series Part III

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What We're Learning About Supporting Evidence-Informed Policymaking

 

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Videos

GREO has captured and summarized many our projects, strategies and initiatives through video. Here are a few examples. You can also visit and subscribe to our YouTube page to stay connected.

Can't find what you're looking for? Contact us.


 

Public Health Approach to Gambling Part 1 - Webinar
Public Health Approach to Gambling Part 2 - Webinar
Gambling Harms - A Public Health Perspective
 

BET Project Success stories

 
 Mind/Body Approach to Problem Gambling Treatment  
 Gambling Education Talks  

 

Topical Papers

A great body of peer-reviewed literature exists exploring gambling harm from a public health perspective, as well as the complex relationships between gambling harm, substance misuse and poor mental health.

Check out our Evidence Centre for more.

Youth Gambling Problems: A Public Health Perspective 

Title: Youth Gambling Problems: A Public Health Perspective

Author(s): Messerlian, C., Derevensky, J., and Gupta, R.

Year published: 2005

Abstract:

Problem gambling has recently emerged as a significant public health issue. While most efforts target adult pathological gamblers, there is growing concern that adolescents and young adults represent the highest risk group for gambling problems. Prevailing public health initiatives addressing youth problem gambling are only beginning to be examined. Drawing upon the Ottawa Charter for Health Promotion as a guiding framework, a prevention model and framework for action are presented to better understand and address problem gambling from a population-based perspective. This framework applies denormalization, protection, prevention, and harm-reduction principles to youth gambling problems and describes primary, secondary and tertiary prevention objectives. A foundation for the development, implementation and evaluation of comprehensive, multi-level health promotion and prevention strategies for youth problem gambling is provided.

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 Gambling and the Health of the Public: Adopting a Public Health Perspective.
Title: Gambling and the Health of the Public: Adopting a Public Health Perspective.

Author: Korn, D.A., and Schaffer, H.J.

Year published: 1999

Abstract: During the last decade there has been an unprecedented expansion of legalized gambling throughout North America.Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gamblingrelated problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:

  1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;
  2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;
  3. Outline the major public health issues about how gambling can affect individuals, families and communities;
  4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.

By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.

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A Tale of Missed Opportunities: Pursuit of a Public Health Approach to Gambling in New Zealand

Title: A Tale of Missed Opportunities: Pursuit of a Public Health Approach to Gambling in New Zealand

Author: Adams, P.J., and Rossen, F.

Year published: 2012

Abstract:

Aim: This paper provides a critical overview a decade after the New Zealand Government announced its intention to formally incorporate a public health approach into its comprehensive revision of gambling legislation.

Method: The initial enthusiasm and the subsequent disillusionment with this approach are tracked. Four reasons for its lack of success are examined.

Findings: The New Zealand experiment with a public health approach to gambling is seen to have floundered in a network of vested interests. The pathways for influence included inappropriate industry input as well as community and government sector reliance on gambling profits. The new legislation neglected to set up systems for strong independent accountability, and this weakened the potential of public health initiatives.

Conclusion: As with tobacco control, the policy integrity of a public health approach to gambling requires close attention to ways of reducing vested interests in both government and community sectors and to establishing strong points of independent accountability.

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 How the Internet is Changing Gambling: Findings from an Australian Prevalence Survey

Title: How the Internet is Changing Gambling: Findings from an Australian Prevalence Survey

Author: Gainsbury, S.M., Russell, A., Hing, N., Wood, R., Lubman, D., and Blaszczynski, A.

Year published: 2015

Abstract:

Interactive gambling as a regulated activity, coupled with easy accessibility to offshore providers represents a new mode and format of gambling superimposed on traditional land-based opportunities. This paper aimed to investigate the prevalence of gambling among Australian adults and the relationship between various gambling activities and interactive modes of access. A second aim was to compare interactive and non-interactive gamblers in terms of socio-demographic characteristics, attitudes and beliefs about gambling and gambling participation. In a nationally representative telephone survey, 15,006 Australian adults completed measures assessing past 12-month gambling participation and a sub-sample completed questions about interactive gambling and beliefs. The majority of participants (64.3 %) reported gambling at least once, with 8.1 % having gambled online. Interactive gamblers gambled on a greater number of activities overall and more frequently. Interactive gamblers were more likely to be male, younger, have home Internet access, participate in more forms of gambling and have higher gambling expenditure. Almost half of the interactive gamblers preferred land-based gambling although a small proportion also noted a number of disadvantages of interactive gambling. This study shows that the nature of gambling participation is shifting with interactive gambling having a significant and growing impact on overall gambling involvement.

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Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys

Title: Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys

Author(s): Lorains, F.K., Cowlishaw, S., Thomas, S.A.

Year published: 2011

Abstract:

Aims: This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers.

Methods: A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies.

Results: Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution.

Conclusions: Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.

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