Patterns and characteristics of adolescent gambling. Families Health , 1, The value of a public health perspective is that it applies different lenses for understanding gambling behaviour, analysing its benefits and costs as well as identifying multilevel strategies for action and points of intervention. North American Training Institute. There is concern that without a concerted focus on understanding and preventing problems among those most vulnerable, the burden of problem gambling among youth will persist.
Some action has also been taken in developing an international governance structure through contact with the World Health Organization WHO.
Given the barriers to penetrating such a large organization, the McGill International Centre has recently developed significant collaboration with the Pan American Health Organization, the Americas' office of the WHO, as an initial starting point. This partnership stimulated the formation of a Task Force of researchers and clinicians from North and South America.
The Task Force's objective is to examine and address high-risk behaviour among Latin American youth. Similarly, in the U. Employing a junior editor and several youth advisors on their team, these youth are responsible for the illustration of characters, writing of articles, and designing of the online and paper-based magazine.
Involving youth in the development and implementation of programs is slowly becoming part of on overall approach to prevention. A public health framework incorporates a multi-dimensional perspective, recognizes the individual and social determinants, draws upon health promotion principles and applies population-based models. Individuals who gamble infrequently, or in a low-risk manner, have few, if any, negative outcomes.
At this level, Korn and Shaffer suggest that some people derive a degree of pleasure, enjoyment, or benefit. As gambling escalates and one moves along the continuum of gambling risk, the negative outcomes begin to outweigh any potential benefits. As a result, adolescent gamblers begin experiencing a wide array of impaired personal, health, financial, and social consequences. The at-risk gambler, while not meeting all the criteria for pathological gambling, is nevertheless experiencing a number of gambling-related problems.
This group remains at greater risk than the low-risk social gambler but is considerably better off than those with significant gambling problems sometimes referred to as pathological gamblers, probable pathological gamblers, disordered gamblers, compulsive gamblers, or Level III gamblers. Youth on this end of the continuum, who gamble at the pathological level, meet established diagnostic criteria and are in need of therapeutic treatment. A public health model incorporates a range of prevention and harm reduction strategies as well as treatment interventions targeted at different levels of risk.
This model is unique in that it delineates two trajectories; the risk continuum and the prevention pathway. The latter moves in the opposite direction and aims to reverse the risk at every level along the continuum; strategies aim to impede the progression at each stage along the range of risk. The model also links clusters of health promotion strategies to prevention objectives, however, the authors suggest tailoring and implementing each strategy to the specific needs of communities or groups.
In addition, Messerlian et al. An ecological approach to health behaviour views gambling behaviour from multiple perspectives. Originally proposed by McLeroy, Bibeau, Steckler, and Glanz , an ecological health promotion model focuses on addressing health behaviour from both an individual and socio-environmental level; strategies are directed at shifting intrapersonal, interpersonal, institutional, community, and public policy factors.
It is the interaction of these five factors that determines one's predisposition to developing a gambling-related problem Jacobs, An ecological perspective on gambling emphasizes moving beyond offering problem gamblers treatment and counselling; instead, interventions work at modifying all five levels within this multi-dimensional model. Intrapersonal and interpersonal level factors have been the focus of considerable research, treatment, and prevention programs in the past.
The aetiology of gambling behaviour and gambling problems, although still not fully understood, includes the interaction of biological, psychosocial, and environmental factors. Institutional structures, regulations, and policies can either promote or hinder health behaviour and outcomes.
These institutional factors can be viewed as targets for change; they can be challenged and modified to help create healthy organizational culture and practices. Public policy factors related to gambling intersect a number of different policy domains including the social, educational, health, economic, legislative and judicial. Governments around the world continue to control and regulate gambling in a manner that promotes and sustains economic benefits.
Changes in the level of economic security have resulted in governments becoming dependent upon revenues generated by the gambling industry, and governments are now reluctant to change regulations in favour of progressive public health policies. Applying political economy theories to gambling, Sauer maintains that gambling expansion has been driven by the need for larger governments to generate greater revenue.
Legislation on advertising and promotion, laws regulating minimum age-requirements and their enforcement, provision of programs for harm minimization, fiscal measures, and regulation of the availability of products are examples of public policy initiatives that can influence the social environment and minimize unhealthy behaviour.
Clearly, however, policies need to balance public health interests with the economic gains to governments and the industry. Moving from levels of action to goals, a public health approach to youth gambling must work at establishing and realizing overall goals in order to guide action along the spectrum of issues.
Denormalization, protection, prevention, and harm reduction have been applied to a public health and youth gambling framework Messerlian et al. Denormalization aims to implement strategies that encourage society to question and assess underage gambling. Not unlike the strategies used in tobacco prevention, denormalization can include drawing attention to the marketing strategies employed by the gambling industry, influencing social norms and attitudes on youth gambling, promoting realistic and accurate knowledge about gambling, and challenging current myths and misconceptions among youth and the general public.
Society has a shared responsibility to protect children and adolescents from potentially harmful activities such as access to and exposure to gambling. This goal as applied to youth gambling should aim to protect youth from exposure to gambling products and promotion through effective institutional policy and government legislation, and reduce the accessibility and availability of all forms of gambling to underage youth.
Further, efforts to protect youth from the direct and indirect marketing and advertising of gambling products and venues is required. Prevention efforts should be targeted at the primary, secondary, and tertiary levels. While much of the focus has been on tertiary prevention, or treatment-based interventions, primary and secondary prevention reach larger numbers of youth, and have potential for a much broader impact.
Prevention objectives should aim to increase knowledge and awareness of the risks of gambling among youth, professionals, and the general public; promote informed decision-making in individuals and families; increase the early identification and treatment of youth experiencing gambling problems or at risk of developing them; help youth develop effective problem-solving, coping, and social skills required for healthy adolescent development; and minimize the harm of gambling problems in youth, their families, and communities.
Harm Reduction is an approach to prevention that is directed at reducing the problem behaviour. In general, harm-reduction strategies target youth already gambling and those at risk. Harm-reduction objectives should reduce the risk of developing a gambling problem among youth who gamble in an at-risk manner, and decrease the potential negative consequences of gambling among youth without necessarily making abstinence a goal see Dickson et al.
Raising awareness and increasing knowledge of the risk and consequences of underage gambling among adolescents, parents, school personnel, health professionals, and the general public are important initial steps in primary prevention and may help achieve denormalization goals.
Implementing health promotion strategies such as health education in schools and health communication within communities can help improve the level of public awareness and knowledge of the hazards of gambling in a young population.
By disseminating persuasive information on unhealthy behaviours to the public and portraying it as an important public issue, mass communication strategies have the potential to influence social norms and attitudes regarding that behaviour Byrne et al.
Effective public health action is most often formulated with an appreciation of the history of each community, and is appropriate within the local context e. Strategies that seek to educate and empower communities may help bring gambling issues to the forefront of the public policy agenda. This critical consciousness raising may empower and enable individuals and groups to be more active in community health issues. Furthermore, involving community groups in the development of programs and the policy-making process may help mobilize action and may create pressure and support for policy changes.
However, these measures are effective only when they form part of an integrated approach, which includes healthy public policy Tones, The latter approach includes, but is not limited to, developing policies and programs offering information to retailers on legal liabilities, and on the importance of enforcing the legal age, all of which help increase barriers for underage youth trying to gamble.
Increasing the age of first exposure to gambling participation by limiting the accessibility and availability of gambling products, venues, and activities, and raising the legal age, are important regulatory policy development issues.
However, most importantly, without the development of policies that cultivate environments supportive of behaviour change, education programs at any level will likely not be effective Campbell et al.
The expansion of gambling is a global phenomenon. The rise of new and existing forms of gambling will continue to grow worldwide, given the lucrative revenues generated for government coffers and for the industry itself. However, the proliferation of the industry and of its ensuing profits has not been without reproach. Anti-lobbying and public-interest groups have tried, albeit mostly unsuccessfully, to curtail the growth of gambling venues in communities and limit the development of new forms of gambling.
Gambling has therefore become an exceedingly contentious social policy issue throughout the world [see reports for the U. Social policies, however, are often established by default, and gambling policy seems to be based upon a harm reduction model rather than abstinence or prohibition see Dickson et al.
Effective social policy needs to be reflective of the existing ideological, social and political context from which it is derived, while concurrently directive of future impact and changes.
Furthermore, social policy should reflect the determinants of health and the link between individuals and communities. This would translate into policies that indirectly target the individual through changes at the social and environmental determinants levels. These efforts can be achieved through the development of both programmatic and regulatory policies.
As the gambling industry continues to burgeon, the adoption of formal laws and regulations governing this expansion, and the establishment of regulatory bodies to monitor the enforcement of such laws as well as assess the impact of gambling upon society, remain important policy initiatives. The aim of such regulatory policies is to reduce the risk of gambling to youth by restricting access to products and services.
However, policies that aim to deter youth from participating in gambling by increasing the minimum-age requirements and the price of products are only effective if there is widespread adherence and enforcement of such policies and statutes.
A lack of awareness among retailers regarding laws and penalties, and among the public on the seriousness of gambling problems, may in fact partly account for the ease with which underage youth purchase lottery tickets in spite of legal prohibitions Felsher et al.
In addition, enforcement is problematic in countries such as Canada: Other key policy considerations include those that contribute to the prevention of gambling problems in youth through funding commitments, and through the implementation and institutionalization of prevention practices Pentz, Examples of programmatic policies include community education and development, training of health services professionals and the development of resources for prevention and treatment, and industry education programs targeting retailers and venue operators, all of which aim to create supportive environments as well as enhance the skills of individuals.
Since the Second International Think Tank on Youth Gambling Issues, a significant amount of research has been conducted to better understand the risk factors, trajectories, and problems associated with excessive youth gambling behaviour.
While not universal, governments and the industry throughout the world have come to understand the importance of this issue and are beginning to provide greater funding for research, prevention, and treatment. The public health model and framework described in this paper has attempted to apply health promotion and prevention theory to youth gambling.
Very few strategies recommended have yet to be implemented or empirically evaluated for effectiveness. It is anticipated that this paper will provide gambling and public health professionals some direction for further work in this area and serve as a starting point for addressing youth gambling issues from this new lens. As more public health strategies become implemented, the model and theories outlined can be tested and assessed for their applicability to youth gambling.
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