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Gambling exposure can be defined as the extent to which populations or population sectors come into contact with gambling activities (Abbott, 2007). Exposure is strongly influenced by availability - that is, the type, number, distribution, and accessibility of gambling activities. Gambling participation is measured by involvement in specific gambling activities and includes assessments of frequency, duration, and expenditure. Participation can become problematic when the gambling participant and/or other people experience harm as a consequence of his or her participation.
Gambling types vary in their potency and ability to lead to harm. Some types of gambling, such as lotteries and raffles, are relatively benign. Other types (e.g., Electronic Gaming Machines (EGMs), casino table games, horse track and sports betting) can more easily lead to harm, especially through regular, prolonged participation, because they are continuous in nature and involve an element of skill or perceived skill (Abbott, Volberg, Bellringer, et al., 2004; Binde, 2011; Raylu & Oei, 2002; Walker, 1992).
There are also indications that problems develop more rapidly in association with some types of gambling (for example EGMs) than others (Evans, 2003), but that these problems may be more transient (Abbott, Williams, & Volberg, 2004). Therefore, it is important to take into account exposure levels for different types of gambling. It is also important to develop more refined ways to assess the risk potential and harm associated with different gambling types, and closely analyze the settings within which they are provided (Peren, 2011). The risk potential of various forms of gambling is discussed in Risk Assessment.
In this section, we discuss the following factors related to gambling exposure in greater detail: gambling setting, accessibility, adaptation, and marketing and messaging. There is a large body of research on gambling participation and harmful gambling, their associations with the availability of particular gambling forms, and changes in participation and problems over time. These studies are predominantly cross-sectional and do not establish the direction of relationships or causality.
Further work is required to develop more refined measures of gambling exposure and the contextual and environmental factors that influence participation and problems. Until recently, there has been a dearth of high quality prospective studies that enable the incidence (onset) of at-risk and harmful gambling to be assessed and which identify the factors implicated in harmful gambling development, including recovery, remission, and relapse.
Studies of this type and natural experiments enable stronger causal inferences to be made. Recent meta-analyses and reviews have provided corroboration for both exposure and adaptation hypotheses (see below). However, research examining factors responsible for adaptation, including the possible impacts of policy and regulatory measures, is in its infancy. A number of longitudinal studies are currently underway that will improve evidence in this area - for example, The Victorian Gambling Study (Victoria Department of Justice, 2011), Swedish Longitudinal Gambling Study (SWELOGS) (Romild, U., Volberg, R., & Abbott, M., 2014; Statensfolkhälsoinstitut, 2010), Massachusetts Gambling Impact Cohort (MAGIC), Leisure, Lifestyle, Lifecycle Project, Canada (LLLP) and the Quinte Longitudinal Study (QLS), Canada.
The context of gambling is of great importance to gambling exposure and to social factors discussed in Social Factors. Apart from jurisdictions, communities, and localities, there are additional, more local contexts within which gambling exposures can vary. These contexts include families and workplaces, as well as reference, cultural, and religious groups. Typically, most people report being introduced to gambling within their family of origin. Starting to gamble at an early age is a risk factor for harmful gambling. People who commence gambling in late adolescence or adulthood more often report being introduced to gambling by external socializing agents, including friends, advertising, colleagues and partners/spouses (Abbott, 2001a).
In the past, increases in gambling have most often been explained by availability of money, availability of gambling options (especially in the case of problem gamblers), and advertising (Abbott, 2001b). One study found that while adults who reported gambling before the age of 13 years were more likely to be current problem gamblers, the same was true of people who reported starting gambling at age 25 or older (Abbott & Volberg, 2000).
Those introduced to gambling in their late teens and early adulthood had a very low prevalence of harmful gambling, raising the possibility that initial participation in adulthood may lead to greater long-term risk of harmful gambling. In a 2006 study, Turner et al. found a non-linear (quadratic) relationship between age of gambling onset and problems (Turner, Zangeneh, & Littman-Sharp, 2006). Most non-problem gamblers began to gamble between the ages of 18 and 23, while pathological gamblers began to gamble either before 18 or after 23. In both studies, it is possible that the elevated risk for later onset gamblers could have been a consequence of the relatively recent introduction of EGMs and casinos.
Spouses or partners and other family members are also most often mentioned as gambling companions, although this varies across venues, gambling forms, and population sectors (Abbott, 2001b). Adolescents and adults who gamble frequently - particularly problem gamblers - report much higher levels of gambling participation in both current families and households, as well as in their family of origin.
Substantial variation in gambling participation has been found across occupational and religious groups. Walker (1992), among others, has cited sociological studies dating back to the 1950s that suggest ways in which work and other reference groups can encourage and discourage gambling. For instance, people working in the gambling industries may have an elevated risk for harmful gambling. Shaffer and Hall (2002) found high rates of harmful gambling among casino employees, especially younger and more recent employees; however, longer-term employees had lower rates. They interpreted this as indicating elevated risk during early exposure, followed by adaptation.