Abstract
Purpose:
Gambling on the lottery is a prevalent behavior, and lottery products are increasingly available in online and electronic formats. As lottery-purchasing is prevalent in adolescents, this study systematically examined relationships between lottery-purchasing and problem-gambling severity and gambling perceptions and attitudes, and differences in the relationships between problem-gambling severity and measures of health/functioning and gambling characteristics among lottery-purchasing groups.
Methods:
Participants were 1,517 Connecticut high-school adolescents with past-year gambling. Chi-square and logistic regression models were conducted, and interactions between problem-gambling severity and lottery-purchasing status on multiple outcomes were determined.
Results:
Lottery-purchasing, compared to non-lottery-purchasing, adolescents had greater problem-gambling severity and reported more permissive gambling attitudes and greater parental approval of gambling. Significant between-group differences were observed, with at-risk/problem-gambling more strongly associated with having friends and adult gambling partners among non-lottery-purchasing adolescents, and machine and online gambling, and gambling alone more strongly associated among lottery-purchasing adolescents.
Conclusions:
Greater problem-gambling severity, permissive gambling attitudes, and parental approval of gambling in lottery-purchasing adolescents suggest that parenting contexts are important considerations in prevention efforts targeting problem gambling in youths. Between-group differences in associations between problem-gambling severity and gambling types and partners may identify high-risk groups associated with more solitary gambling behaviors for whom targeted interventions may be adapted.
Keywords: lottery, gambling, addictive behaviors, adolescent, high school, problem behaviors
INTRODUCTION
Despite age restrictions, lottery gambling, including scratch cards, raffles, and number draws, are among the most prevalent and widespread forms of gambling in youth (Fisher 1999; Jackson et al. 2008; Splevins et al. 2010; Jaisoorya et al. 2017; Liu et al. 2013). In the United States, an estimated 49% of individuals over age 14 years have reported past-year gambling on the lottery (Barnes et al. 2011). In Europe, 9.9% and 7.6% of high-school adolescents, respectively, have participated in past-year offline and online lotteries (Molinaro et al. 2018). Reports from adults who gamble suggest that 48.3% have gambled on scratch cards and 11.3% on lotteries before the age of 16 years (Tomei et al. 2015). High-school adolescents with problem/pathological gambling, relative to those with at-risk gambling, have greater likelihoods of engaging in non-strategic gambling including lottery-purchasing (Yip et al. 2011). Additionally, greater frequency of lottery-purchasing is associated with problematic gambling (Booth et al. 2020).
Parents’ gambling and involvement in their children’s gambling contribute to engagement in lottery gambling and problematic gambling in youth. Parental and child participation in national-lottery and scratch-card gambling are highly associated (p<0.0005) (Wood and Griffiths 1998). While the sale of lottery products to minors is illegal, parents have often purchased lottery tickets for their children (Ariyabuddhiphongs 2011). Among middle- and high-school students, a difference between those with at-risk gambling, social gambling, and probable pathological gambling, defined by scores ≥4 out of 9 domains of youth pathological gambling on the DSM-IV-MR-J, has been found in individuals having parents who purchased lottery draws on their behalf (p=.001), and 32% continued to gamble on the lottery because their parents also did (Felsher et al. 2003). While varying across adolescent age and lottery type within this epidemiological cohort, 73.9% of adolescents with probable pathological gambling, 52.3% with social gambling, and 53.3% with at-risk gambling had parent-facilitated purchasing of lottery draws, respectively (Felsher et al. 2003). Hence, adolescents who perceived excessive gambling in parents and family may have additional risk of problem gambling (Zhai et al. 2017). However, while differences in problem-gambling severities have been associated with lottery gambling and parent-facilitated lottery-purchasing, the relationships between self-purchasing of lottery gambling products and relationships with problem-gambling severities and other gambling-related measures require further examination.
Previous research has examined relationships between receipt of lottery tickets as gifts, gambling problems and behaviors, and health measures in youth. Adolescents who were gifted lottery tickets, compared to those not gifted lottery tickets, were more likely to purchase instant and other lotteries, and were more likely to have at-risk/problem gambling (Kundu et al. 2013). Among lottery-gifted adolescents, at-risk/problem gambling was associated with greater likelihoods of poor grades, drug use, heavy alcohol use, and violence (Kundu et al. 2013). However, as up to 71% of adolescent lottery gambling has been facilitated by family purchasing (Wood and Griffiths 2004; Wood et al. 2002), the relationships between adolescent self-purchasing of lottery products, which requires direct engagement in norm-violating behaviors, and other gambling measure are not well understood. Problem behavior theory has suggested that adolescent engagement in multiple risky behaviors including gambling, aggression, and substance use have high likelihoods of co-occurring (Jessor, 1987; Jessor & Jessor, 1977; Magoon & Ingersoll, 2006).
In addition to family facilitation of gambling, adolescents who experience family members engaging or promoting gambling may have more positive perceptions of gambling behavior. Data from a national survey suggested that parents of adolescents often perceived gambling as less harmful than other behaviors and were more likely to view older adolescent exposure to gambling stimuli (watching poker on television) and occasional gambling as acceptable (Campbell et al. 2011). Lottery gambling has been associated with perceiving lotteries as a “good idea” (Wood and Griffiths 2004), and being gifted lottery tickets has been associated with parental approval and positive perceptions of gambling (Kundu et al. 2013). Additionally, gambling among peer groups who share similar behaviors may become normative, promote gambling perceptions as socially acceptable, and lead to less caution regarding gambling behaviors (Shead et al. 2010; Deans et al. 2017). Self-identifying within the gambling students group, relative to non-gambling and general students, has been associated with gambling behaviors, and self-identification moderated the relationship between perceived norms in gambling and gambling behaviors (Foster et al. 2014). Furthermore, being gifted lottery tickets has been associated with permissive gambling perceptions including viewing warning from peers and learning about risk of gambling from peers as not important (Kundu et al. 2013). For these reasons, relationships between self-purchasing of lottery products and gambling perceptions require further examination. Together, evidence suggest that problem gambling and lottery-purchasing are linked in adolescents, and relate importantly to health and functioning. However, how problem gambling, gambling perceptions and behaviors, and health/functioning measures may differ between lottery-purchasing and non-lottery-purchasing adolescents is not well understood. Additionally, while studies have examined contributions of problem gambling and lottery-purchasing to health/functioning separately, few studies have directly examined their interactive effects. As only 60% of vendors have been previously demonstrated to comply with minimum-age lottery purchasing requirements (St-Pierre et al. 2011), understanding these relationships may inform critical prevention efforts that focus on lottery-purchasing and problem gambling.
To address gaps in the literature, the current study examined relationships between problem-gambling severity and health/functioning and gambling characteristics in adolescents stratified by lottery-purchasing status. The study hypothesized that: 1) lottery-purchasing would be associated with greater problem-gambling severity; 2) lottery-purchasing adolescents would report more permissive attitudes towards gambling among family and peers; and, 3) the association between problem-gambling severity and poorer health/functioning in lottery-purchasing adolescents would be stronger compared to those in non-lottery-purchasing adolescents. Follow-up exploratory analyses were conducted to probe possible differences in associations between problem-gambling severity and gambling characteristics including gambling types, motivations, and partners in adolescents stratified by lottery-purchasing status.
METHODS
Recruitment and Survey Characteristics
Data were derived from a cross-sectional, anonymous survey among high-school students as described previously (Yip et al. 2011; Zhai et al. 2017; Zhai et al. 2020). Invitations were extended to public 4-year and non-vocational or special-education high-schools in the state of Connecticut (USA). Further target recruitment ensured adequate representation of all four geographic quadrants of Connecticut, and the three tiers of the state’s family-socioeconomic-status-related district reference groups to ensure socioeconomic representation. For schools that expressed interest, permission was obtained from school boards and/or school system superintendents when necessary. Passive parental consent and student assent procedures were approved by the Yale School of Medicine institutional review board and data collection sites. Letters were mailed to parents outlining the study and instructed them to contact the school if they declined their child’s participation. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration or comparable ethical standards. Surveys were administered at each school on a single day. Students were reminded that participation was voluntary and answers were anonymous, and the refusal rate was <1%.
The survey contained 154 questions that assessed demographic characteristics, gambling behaviors, types, and motivations, health and functioning, and items derived from established measures including the Massachusetts Gambling Screen (Shaffer et al. 1994). Consistent with nationally representative epidemiological youth risk behaviors surveillance (YRBS), adolescents were assessed on current participation in gambling in the past-year (CDC 2017; Kann et al. 2018). Of the 3,836 student who completed the lottery-purchasing measures, 1,517 students endorsed past-year gambling and completed all 12 questions corresponding to inclusion criteria for problem-gambling severity.
Measures
Demographic Characteristics:
Measures of demographic characteristics included self-reported gender, race/ethnicity, grade in school (e.g., 9th-grade), age, and family structure (e.g., living with one parent). Sample demographics were consistent with reports from the 2000 Census of Connecticut residents between ages 14–18 years (Schepis et al. 2008; Yip et al. 2011). All binary and multinomial logistic regression models regarding problem-gambling severity were adjusted to account for possible effects of demographic measures.
Lottery-Purchasing Group:
Lottery-purchasing status was assessed using the questions: “In the past 12 months, [how often] have you…” “bought instant lottery or scratch tickets for yourself?” and “bought other lottery tickets (e.g., Powerball) for yourself?”. Responses included: ‘never’, ‘less-than-monthly’, ‘monthly’, ‘weekly’ and ‘daily.’ Adolescents were stratified into two lottery-purchasing groups. Those who responded “never” to both questions were designated as non-lottery-purchasing, and responses of “less than a month” or greater frequencies for either questions were designated as lottery-purchasing. Of the 1,517 adolescents with current gambling studied, 495 (32.6%) participants were classified as lottery-purchasing and 1022 (67%) participants were classified as non-lottery purchasing.
Problem-Gambling Severity:
Problem-gambling severity was assessed using the Massachusetts Gambling Screen, a self-report assessment tool based on DSM-IV criteria for pathological gambling that has demonstrated adequate reliability (Cronbach’s=0.83–0.87) and predictive and construct validity (Shaffer et al. 1994). Based on MAGS responses, participants were stratified into two problem-gambling-severity groups as in previous studies (Potenza et al. 2011; Slavin et al. 2013; Foster et al. 2015). Of the 1,517 adolescents who reported past-year gambling included in the study, 975 (64.3%) with no endorsed diagnostic criteria were classified as having low-risk gambling (LRG) and 542 (35.7%) who endorsed one or more criteria were classified as having at-risk/problem-gambling (ARPG).
Pathological/Disordered Gambling:
To assess between-lottery-purchasing-group differences in the contexts of DSM-IV pathological gambling and DSM-5 gambling disorder, MAGS responses were used to stratify adolescents into additional gambling groups. Following the stratification described previously (Desai and Potenza 2008; Yip et al. 2011), adolescents who reported at least five out of ten inclusionary criteria for DSM-IV pathological gambling were designated as having pathological gambling (PG), or otherwise were designated as non-pathological-gambling (non-PG). Adolescents who reported four out of nine inclusionary criteria for DSM-5 gambling disorder (excluding the illegal acts criterion) were designated as having gambling disorder (GD), or otherwise were designated as non-gambling-disordered (non-GD).
Perceived gambling attitudes:
Participants indicated perceived gambling attitudes relating to family and peers by responding (important vs. not-important) to the question, “How would you rate the following in their importance for preventing gambling problems in people your age?” for items including: ‘Checking identification for purchasing lottery tickets’; ‘Hanging out with friends who do not gamble’; ‘Participating in activities that are fun and free of gambling.’ Participants completed the question on their parents’ perceptions of gambling (disapprove, approve, or neither): ‘How do you think your parents would feel about you gambling, even once or twice, over the next 12 months?’ Participants also indicated whether they perceived family gambling problems (yes/no) on the question: ‘Has the gambling of a close family member caused you worry or concern?’
Health and Functioning:
Health and functioning were assessed and coded as previously described (Yip et al. 2011; Desai and Potenza 2008; Schepis et al. 2008; Slavin et al. 2013; Zhai et al. 2020) on the following established measures: grade average (A-B’s, C’s, D’s or lower); engaged in any extracurricular activities (yes/no); lifetime tobacco smoking (never regular, occasionally, regularly), lifetime marijuana use (yes/no); lifetime other drug-use (yes/no); lifetime (yes/no) and current past 30-days alcohol use (never, regular, light, moderate, heavy); past-year dysphoria/depression (yes/no). Consistent with the national epidemiological YRBS data, tobacco use was coded to differentiate frequency of usage, and alcohol use was differentiated from binge-drinking (Kann et al. 2018). Adolescents also reported on violence-related measures including: past 30-days carrying a weapon such as a gun, knife, or club (yes/no), and did not go to school because they felt unsafe (yes/no); and past 12-months had someone threatened or injured them with a weapon (yes/no), were in a physical fight (yes/no), and were injured in a physical fight requiring treatment by a doctor or nurse (yes/no).
Gambling Characteristics:
Participants were assessed on the presence (yes/no) of a range of gambling behaviors and motivations including: gambling locations (online, school, casino); gambling triggers (pressure, anxiety); gambling reasons (excitement, financial, escape, social); gambling partners (family, friends, adults, strangers, alone); time spent gambling (≤1 hour, ≥2 hours per-week); and gambling age of onset (≤8, 9–11, 12–14, and ≥15 years old). Participants also reported on different gambling types. Adolescents who endorsed any of the following items: gambling on cards, bets with bookies, bets on video or arcade games, bets on dice, and bets on pool or other games of skill were designated as having played “games of skill” involving chance (i.e. strategic gambling). Adolescents were designated as having non-strategic gambling (i.e., “games of chance” not involving skill) if they endorsed any of the following items: receiving instant lottery or scratch tickets, receiving other lottery tickets, and participating in bingo at a church, synagogue, or other public places. Furthermore, those who endorsed having wagered on slot machines, poker machines, or other gambling machines were designated as having machine gambling.
Statistical analysis:
To ensure accuracy, data were double-entered and randomly spot-checked as previously described (Yip et al. 2011; Potenza et al. 2011). Statistical analyses were conducted with SPSS 26. Pearson chi-square analyses compared the frequency distributions of demographic characteristics, problem-gambling severity, pathological/disordered gambling status, gambling perceptions, and health/functioning measures between lottery-purchasing groups. Analyses applied a Bonferroni correction for multiple comparisons such that chi-squares with p-values of p≤0.0025 were considered significant. Binomial and multinomial logistic regressions models were constructed to test associations between problem-gambling severity and nominal outcomes in adolescents stratified by lottery-purchasing status, and odd-ratios (ORs) and 95% confidence interval (CIs) were computed. Interaction models were fitted to determine significant between-group differences in relationships with problem-gambling severity, and were indicated by significant interaction odds ratios. Follow-up exploratory chi-square and regression analyses probed possible relationships between problem-gambling severity and gambling characteristics in adolescents stratified by lottery-purchasing status. The distribution of problem-gambling severity among lottery-purchasing and non-lottery purchasing adolescents is summarized in Table 1, and the distribution of health/functioning between problem-gambling severities stratified by lottery-purchasing status is shown in Table 1 and Supplemental Table 1. Measures with insufficient data for chi-square analysis of frequency distribution were not included in further regression models. As differences in demographic characteristics have been associated with lottery-gambling (Subramaniam et al. 2016; Barnes et al. 2011; Booth et al. 2020), all models included covariates of gender, race/ethnicity, grade in school, and family structure to statistically control for potentially confounding effects. Significance was set at p≤0.05.
Table 1.
Demographic characteristics of adolescents reporting lottery- and non-lottery-purchasing
Non-Lottery-Purchasing (N=1022) | Lottery-Purchasing (N=495) | Effect Size | |||||
---|---|---|---|---|---|---|---|
Dependent Variable | N | % | N | % | χ2 | p | Cohen’s W |
Gender | 0.34 | 0.56 | 0.02 | ||||
Male | 651 | 64.6 | 324 | 66.1 | |||
Female | 357 | 35.4 | 166 | 33.9 | |||
Race/Ethnicity | |||||||
Caucasian | 7.36 | 0.007 | 0.07 | ||||
No | 272 | 26.8 | 100 | 20.4 | |||
Yes | 743 | 73.2 | 391 | 79.6 | |||
African-American | 9.5 | 0.002 | 0.08 | ||||
No | 887 | 87.4 | 455 | 92.7 | |||
Yes | 128 | 12.6 | 36 | 7.3 | |||
Asian | 1.06 | 0.3 | 0.03 | ||||
No | 975 | 96.1 | 466 | 94.9 | |||
Yes | 40 | 3.9 | 25 | 5.1 | |||
Hispanic | 2.31 | 0.13 | 0.04 | ||||
No | 830 | 85.3 | 388 | 82.2 | |||
Yes | 143 | 14.7 | 84 | 17.8 | |||
Other | 0.99 | 0.32 | 0.03 | ||||
No | 848 | 82.5 | 420 | 85.5 | |||
Yes | 167 | 16.5 | 71 | 14.5 | |||
Grade | 20.05 | <.001 | 0.12 | ||||
9th | 324 | 31.8 | 135 | 27.4 | |||
10th | 264 | 25.9 | 104 | 21.1 | |||
11th | 260 | 25.5 | 125 | 25.4 | |||
12th | 171 | 16.8 | 129 | 26.2 | |||
Age | 50.52 | <.001 | .21 | ||||
≤14 years | 132 | 17.1 | 58 | 15 | |||
15–17 years | 553 | 71.8 | 222 | 57.5 | |||
≥18 years | 85 | 11 | 106 | 27.5 | |||
Family Structure | 3.23 | 0.2 | .05 | ||||
One parent | 242 | 23.9 | 110 | 22.7 | |||
Two parents | 712 | 70.4 | 336 | 69.3 | |||
Other | 57 | 5.6 | 39 | 8 | |||
Problem-Gambling Severity | 41.16 | <.001 | .17 | ||||
Low-Risk Gambling | 713 | 69.8 | 262 | 52.9 | |||
At-risk/Problem Gambling | 309 | 30.2 | 233 | 47.1 | |||
Pathological-Gambling | 55.56 | <.001 | .19 | ||||
Non-Pathological Gambling | 992 | 97.1 | 432 | 87.3 | |||
Pathological Gambling | 30 | 2.9 | 63 | 12.7 | |||
Gambling Disorder | 46.42 | <.001 | .18 | ||||
Non-Gambling Disorder | 978 | 95.7 | 425 | 85.9 | |||
Gambling Disorder | 44 | 4.3 | 70 | 14.1 |
RESULTS
Problem Gambling and Demographic Characteristics
The frequencies and chi-square results of problem-gambling severities and demographic characteristics between lottery-purchasing groups are shown in Table 1. In reference to the first hypothesis, lottery-purchasing was associated with problem-gambling severity. Among lottery-purchasing adolescents, 47.1% were classified as having ARPG, and among non-lottery-purchasing adolescents, 30.2% were classified as having ARPG, generating a significant between-group difference (χ2=41.16, p<.001). Of the lottery-purchasing adolescents, 12.7% were classified as having PG compared to 2.9% of non-lottery-purchasing adolescents, generating a significant between-group difference (χ2=55.56, p<.001). Furthermore, 14.1% of lottery-purchasing adolescents were classified as having GD compared to 4.3% of no lottery-purchasing adolescents, which produced a significant between-group difference (χ2=46.42, p<0.001). Additionally, among lottery-purchasing adolescents, 66.1% were male and 33.9% were female; 15% of lottery-purchasing adolescents were aged ≤14 years, 57.5% were 15–17 years, and 27.5% were ≥18 years. Additionally, 27.4%, 21.1%, 25.4%, and 26.2% of lottery-purchasing adolescents attended the 9th, 10th, 11th, and 12th grades, respectively. Among lottery-purchasing adolescents, 79.6% identified as Caucasian, 7.3% as African-American, 5.1% as Asian, 17.8% as Hispanic, and 14.5% as “other race”; 22.7% lived with one parent, 69.3% lived with two parents, and 8% had “other living arrangements.”
Perceived Gambling Attitudes
Chi-square results of adolescent perceived gambling attitudes between lottery-purchasing groups are shown in Table 2. Pertaining to the second hypothesis, lottery-purchasing adolescents reported more permissive attitudes towards gambling. Among those reporting lottery-purchasing, a range of 54.6%−80.8% endorsed gambling prevention and non-permissiveness towards gambling as important, and a range of 62.6%−89.8% of non-lottery-purchasing adolescents rated these measures as important. Significant associations were found between lottery-purchasing status and a majority of perceived gambling attitude measures. Lottery-purchasing, compared to non-lottery-purchasing, adolescents more frequently rated gambling prevention measures involving peer and social contexts as not important. These included: checking identification for purchasing lottery tickets; hanging out with friends who do not gamble; participating in activities that are fun and free of gambling; fear of losing valuable possessions, close friends, and relatives; advertisements that show the problems associated with gambling; learning about the risks of gambling in school; learning about the risks of gambling from peers; and warning from, or listening to, peers. Lottery-purchasing adolescents also more frequently rated measures related to parental monitoring and family non-involvement in gambling as not important. These include: not having access to internet gambling at home; parent/guardian strictness about gambling; warning from adults in family; having parents who do not gamble; learning about the risks of gambling from parents; adults not involving kids in gambling; parent/guardian not permitting card games for money at home. In addition, lottery-purchasing compared to non-lottery purchasing adolescents perceived parents as approving of adolescent gambling more frequently, but concerns for a close family member’s gambling did not differ between groups.
Table 2:
Gambling perceptions in lottery-purchasing and non-lottery-purchasing adolescents
Non-Lottery-Purchasing | Lottery-Purchasing | Effect Size | |||||
---|---|---|---|---|---|---|---|
Variable | N | % | N | % | χ2 | p | Cohen’s W |
Parent perception of gambling | 55.17 | <.001 | .20 | ||||
Disapprove | 336 | 36.7 | 103 | 23.7 | |||
Neither approve nor disapprove | 506 | 55.2 | 241 | 55.4 | |||
Approve | 74 | 8.1 | 91 | 20.9 | |||
Importance for preventing gambling problems in teens (Important) | |||||||
Checking identification for purchasing lottery tickets | 804 | 82.4 | 329 | 69.7 | 30.02 | <.001 | .14 |
Hanging out with friends who don’t gamble | 703 | 72.5 | 286 | 61.5 | 17.66 | <.001 | .11 |
Participating in activities that are fun and free of gambling | 806 | 83.1 | 331 | 70.3 | 31.29 | <.001 | .15 |
Fear of losing valuable possessions, close friends, and relatives | 871 | 89.8 | 378 | 80.8 | 22.52 | <.001 | .13 |
Advertisements that show the problems associated with gambling | 743 | 76.9 | 302 | 64.4 | 25.02 | <.001 | .13 |
Not having access to internet gambling at home | 608 | 63.1 | 255 | 54.6 | 9.42 | 0.002 | .08 |
Parent/Guardian strictness about gambling | 766 | 79.3 | 320 | 68.2 | 21 | <.001 | .12 |
Warning from adults in family | 770 | 80 | 325 | 69 | 21.03 | <.001 | .12 |
Warning from, or listening to, peers | 779 | 81 | 330 | 70.5 | 19.8 | <.001 | .12 |
Having parents who don’t gamble | 764 | 79.3 | 303 | 64.7 | 35.36 | <.001 | .16 |
Learning about the risks of gambling in school | 732 | 75.9 | 293 | 62.7 | 26.94 | <.001 | .14 |
Learning about the risks of gambling from parents | 782 | 80.9 | 324 | 69.4 | 23.57 | <.001 | .13 |
Learning about the risks of gambling from peers | 746 | 77.2 | 305 | 65.2 | 23.4 | <.001 | .13 |
Adults not involving kids in gambling | 786 | 81.7 | 324 | 69.2 | 28.2 | <.001 | .14 |
Parent/Guardian not permitting card games (for money) at home | 603 | 62.6 | 240 | 51.1 | 17.21 | <.001 | .11 |
Family Concern (Yes) | 108 | 11.3 | 67 | 14.4 | 2.85 | 0.09 | .05 |
Health and Functioning
Findings of relationships between problem-gambling severity and health/functioning measures in lottery-purchasing and non-lottery-purchasing adolescents are summarized in Table 3 and Supplemental Table 1. Pursuant to the third hypothesis, significant interactions between lottery-purchasing status and problem-gambling severity was found for occasional smoking. After inverse-transformation of the ORs less-than-one, lottery-purchasing adolescents with ARPG compared to LRG were 2.04 (1/OR=0.49) times less likely to have occasionally smoked tobacco. Additionally, among both lottery-purchasing and non-lottery-purchasing adolescents, those with ARPG compared to LRG were more likely to report lifetime marijuana use, weapon-carrying, feeling unsafe, being threatened by a weapon, physical-fighting, and serious physical fighting leading to injury. Among only non-lottery-purchasing adolescents, those with ARPG compared to LRG were more likely to have grade averages of D’s or lower; occasional and regular tobacco smoking; and dysphoria/depression.
Table 3:
Adjusted multivariate analyses of problem-gambling severity and health/functioning stratified by lottery-purchasing status
Non-Lottery-Purchasing | Lottery-Purchasing | Non-Lottery-Purchasing [ARPG vs. LRG] vs. Lottery-Purchasing [ARPG vs. LRG] | |||||||
---|---|---|---|---|---|---|---|---|---|
ARPG vs. LRG | ARPG vs. LRG | ||||||||
Variable | OR | 95%CI | p | OR | 95%CI | p | Interaction OR | 95%CI | p |
Academic and Extracurricular | |||||||||
Any extracurricular activities | 1.09 | .76–1.58 | 0.64 | 1.25 | .80–1.96 | 0.33 | 1.23 | .70–2.14 | 0.47 |
Grade average | |||||||||
A’s and B’s | Ref. | Ref. | Ref. | ||||||
Mostly C’s | 1.35 | .98–1.87 | 0.07 | 0.93 | .59–1.46 | 0.74 | 0.68 | .40–1.16 | 0.16 |
D’s or lower | 1.97 | 1.25–3.09 | 0.003 | 1.36 | .79–2.35 | 0.27 | 0.66 | .33–1.30 | 0.23 |
Substance Use | |||||||||
Smoking, ever | |||||||||
Never | Ref. | Ref. | Ref. | ||||||
Occasionally | 1.86 | 1.33–2.59 | <.001 | 0.97 | .60–1.57 | 0.89 | 0.49 | .28–.86 | 0.01 |
Regularly | 1.83 | 1.16–2.89 | 0.009 | 1.1 | .67–1.80 | 0.71 | 0.73 | .38–1.38 | 0.33 |
Marijuana Use, ever | 1.39 | 1.02–1.89 | 0.04 | 1.52 | 1.00–2.37 | 0.05 | 1.67 | .71–1.93 | 0.55 |
Alcohol use, ever | 1.14 | .69–1.88 | 0.6 | 0.76 | .28–2.07 | 0.59 | 0.72 | .26–2.02 | 0.54 |
Alcohol use, current | |||||||||
Never regular | Ref. | Ref. | Ref. | ||||||
Light | 1.17 | .74–1.85 | 0.51 | 1.06 | .53–2.12 | 0.88 | 1.03 | .47–2.25 | 0.95 |
Moderate | 1.14 | .72–1.80 | 0.58 | 0.85 | .44–1.66 | 0.64 | 0.89 | .42–1.92 | 0.78 |
Heavy | 0.88 | .42–1.72 | 0.71 | 1.65 | .78–3.52 | 0.19 | 2.36 | .91–6.12 | 0.08 |
Other drug use, ever | 1.73 | .95–3.14 | 0.07 | 1.44 | .85–2.46 | 0.18 | 1.15 | .54–2.46 | 0.71 |
Caffeine use | |||||||||
None | Ref. | Ref. | Ref. | ||||||
1–2 per day | 0.68 | .45–1.02 | 0.06 | 0.99 | .55–1.77 | 0.97 | 1.26 | .64–2.48 | 0.51 |
3+ per day | 0.98 | .63–1.51 | 0.91 | 1.1 | .61–1.98 | 0.76 | 1.01 | .50–2.05 | 0.97 |
Mood | |||||||||
Dysphoria/Depression | 2.02 | 1.39–2.96 | <.001 | 1.7 | 1.02–2.84 | 0.43 | 0.82 | .45–1.48 | 0.51 |
Violence | |||||||||
Weapon-Carrying | 1.69 | 1.21–2.35 | 0.002 | 1.69 | 1.11–2.58 | 0.01 | 1.06 | .63–1.78 | 0.84 |
Felt Unsafe | 2.44 | 1.41–4.24 | 0.001 | 4.22 | 1.98–9.01 | <.001 | 1.61 | .66–3.88 | 0.29 |
Threatened by Weapon | 1.94 | 1.36–2.77 | <.001 | 2.34 | 1.45–3.75 | <.001 | 1.23 | .70–2.17 | 0.48 |
Physical Fighting | 1.62 | 1.20–2.20 | 0.002 | 1.55 | 1.03–2.33 | 0.04 | 0.96 | .58–1.57 | 0.86 |
Physical Fighting with Injury | 2.23 | 1.35–3.69 | 0.002 | 1.94 | 1.06–3.54 | 0.03 | 0.95 | .44–2.01 | 0.88 |
Note: ARPG = At-risk/Problem Gambling, LRG = Low-risk Gambling, OR = odds ratio; OR’s controlled for gender, ethnicity, grade, and family structure. Reference Group = Low-Risk Gambling
Gambling Characteristics
Results from exploratory analyses of associations between problem-gambling severity and endorsement of gambling characteristics between lottery-purchasing and non-lottery purchasing adolescents are shown in Table 4 and Supplemental Table 2. Among both lottery-purchasing and non-lottery-purchasing adolescents, those with ARPG compared to LRG were more likely to have bet with bookies and with friends; bet on video-games, dice, games of skill, and other gambling types; and, gambled on the internet, on school grounds, and at casinos. ARPG compared to LRG adolescents were also more likely to have gambled for excitement/fun, financial reasons, escape/dysphoria relief; gambled to relieve pressure and relieve anxiety; gambled alone; and gambled with adults, strangers, and siblings. Lottery-purchasing adolescents with ARPG, compared to LRG, were more likely to have received lottery tickets as gifts, played bingo, and have machine gambling, and were less likely to have gambling onset after 15 years of age. Non-lottery-purchasing adolescents with ARPG, compared to LRG, were more likely to have strategic gambling, gambled for social reasons, and gambled with friends and with parents.
Table 4.
Adjusted multivariate analyses of problem-gambling severity and gambling characteristics stratified by lottery-purchasing status
Non-Lottery-Purchasing | Lottery-Purchasing | Non-Lottery-Purchasing [ARPG vs. LRG] vs. Lottery-Purchasing [ARPG vs. LRG] | |||||||
---|---|---|---|---|---|---|---|---|---|
ARPG vs. LRG | ARPG vs. LRG | ||||||||
Variable | OR | 95%CI | p | OR | 95%CI | p | Interaction OR | 95%CI | p |
Gambling Type | |||||||||
Machine Gambling | 1.29 | .90–1.84 | 0.17 | 2.58 | 1.70–3.90 | <.001 | 2.17 | 1.28–3.66 | 0.004 |
Strategic Gambling | 4.27 | 1.25–14.54 | 0.02 | 7.76 | .94–64.12 | 0.06 | 2.2 | .20–24.32 | 0.51 |
Cards | 1.83 | .96–3.49 | 0.07 | 2.06 | .77–5.46 | 0.15 | 1.57 | .51–4.79 | 0.43 |
Bet With Bookies | 3.9 | 2.31–6.61 | <.001 | 3.57 | 2.12–6.00 | <.001 | 0.92 | .45–1.90 | 0.83 |
Bet On Video Games | 2.1 | 1.54–2.86 | <.001 | 2.88 | 1.90–4.37 | <.001 | 1.34 | .80–2.40 | 0.27 |
Bet On Dice | 2.51 | 1.78–3.55 | <.001 | 2.76 | 1.80–4.23 | <.001 | 1.06 | .62–1.81 | 0.83 |
Bet On Game Of Skill | 2.16 | 1.59–2.93 | <.001 | 3.56 | 2.25–5.64 | <.001 | 1.79 | 1.05–3.05 | 0.03 |
Bet With Friends | 1.96 | 1.25–3.06 | 0.003 | 2.51 | 1.29–4.90 | 0.007 | 1.24 | .58–2.64 | 0.58 |
Non-Strategic Gambling | 1.02 | .75–1.38 | 0.9 | 1.51 | .82–2.75 | 0.18 | 1.53 | .82–2.87 | 0.19 |
Receive Instant Lottery | 1.05 | .78–1.43 | 0.74 | 1.46 | .88–2.42 | 0.14 | 1.59 | .91–2.80 | 0.1 |
Receive Other Lottery | 1.36 | .97–1.91 | 0.07 | 2.91 | 1.93–4.39 | <.001 | 2.35 | 1.42–3.91 | 0.001 |
Bingo | 1.01 | .74–1.40 | 0.94 | 2.09 | 1.36–3.21 | 0.001 | 2 | 1.20–3.31 | 0.01 |
Other Gambling | 2.16 | 1.60–2.92 | <.001 | 2.85 | 1.81–4.48 | <.001 | 1.25 | .74–2.10 | 0.41 |
Gambling Location | |||||||||
Internet | 1.88 | 1.30–2.72 | 0.001 | 3.71 | 2.39–5.74 | <.001 | 1.91 | 1.10–3.34 | 0.02 |
School | 3.33 | 2.43–4.57 | <.001 | 3.91 | 2.49–6.14 | <.001 | 1.22 | .71–2.09 | 0.48 |
Casino | 2.47 | 1.37–4.46 | 0.003 | 3.49 | 1.98–6.16 | <.001 | 1.99 | .91–4.39 | 0.09 |
Gambling Motivation | |||||||||
Excitement/Fun | 3.07 | 2.06–4.57 | <.001 | 2.87 | 1.59–5.17 | <.001 | 1 | .50–1.98 | 0.99 |
Financial | 2.63 | 1.93–3.60 | <.001 | 4.56 | 2.69–7.73 | <.001 | 1.61 | .90–2.90 | 0.11 |
Escape/Relieve Dysphoria | 2.21 | 1.62–3.00 | <.001 | 2.28 | 1.51–3.45 | <.001 | 1.08 | .66–1.76 | 0.76 |
Social | 1.85 | 1.37–2.5 | <.001 | 1.41 | .95–2.10 | 0.09 | 0.79 | .49–1.28 | 0.34 |
Gambling Urges | |||||||||
Pressure | 3.15 | 1.89–5.22 | <.001 | 3.81 | 1.87–7.75 | <.001 | 1.2 | .52–2.80 | 0.67 |
Anxiety | 9.86 | 3.14–30.94 | <.001 | 15.86 | 5.36–46.92 | <.001 | 1.74 | .38–8.05 | 0.48 |
Early Gambling | |||||||||
Age of Onset | |||||||||
≤8 years | Ref. | Ref. | Ref. | ||||||
9–11 years | 1.13 | .65–1.97 | 0.67 | 0.92 | .45–1.88 | 0.82 | 0.76 | .32–1.83 | 0.54 |
12–14 years | 0.87 | .54–1.41 | 0.57 | 0.61 | .32–1.14 | 0.12 | 0.66 | .31–1.41 | 0.28 |
≥15 years | 0.81 | .48–1.36 | 0.42 | 0.34 | .17–.67 | 0.002 | 0.39 | .17–.87 | 0.02 |
Gambling Partners | |||||||||
Alone | 2.03 | 1.18–3.48 | 0.01 | 5.26 | 2.68–10.32 | <.001 | 2.66 | 1.16–6.11 | 0.02 |
Friends | 2.14 | 1.39–3.29 | 0.001 | 0.95 | .57–1.60 | 0.85 | 0.45 | .24–.86 | 0.02 |
Parents | 2.07 | 1.44–2.98 | <.001 | 1.37 | .89–2.11 | 0.16 | 0.73 | .42–1.25 | 0.25 |
Other Adults | 3.2 | 2.10–4.89 | <.001 | 1.69 | 1.06–2.71 | 0.03 | 0.54 | .29–.99 | 0.05 |
Family | 1.08 | 0.80–1.46 | 0.61 | 1.21 | .75–1.67 | 0.58 | 1.05 | .65–1.70 | 0.83 |
Strangers | 3.55 | 1.91–6.59 | <.001 | 4.58 | 2.45–8.55 | <.001 | 1.41 | .60–3.30 | 0.43 |
Siblings | 1.72 | 1.25–2.36 | 0.001 | 1.62 | 1.05–2.50 | 0.03 | 0.85 | .51–1.41 | 0.53 |
Note: ARPG = At-risk/Problem Gambling, LRG = Low-risk Gambling, OR = odds ratio; OR’s controlled for gender, ethnicity, grade, and family structure. Reference Group = Low-risk Gambling
Significant interactions between problem-gambling severity and lottery-purchasing status were found for machine gambling; betting on games of skill; receiving lottery tickets as gifts; playing bingo; gambling on the internet; onset of gambling after age 15; gambling alone; and gambling with friends and with adults. Specifically, lottery-purchasing adolescents with ARPG compared to LRG were more likely than non-lottery-purchasing adolescents with ARPG compared to LRG to have machine gambling at 2.68 odds, bet on games of skill at 3.56 odds, receive other lottery at 1.46 odds, gamble on bingo at 2.09 odds, gamble on the internet at 3.71 odds, and gamble alone at 5.26 odds, and less likely to have gambling initiation after age 15 at 0.39 odds, gamble with friends at 0.45 odds, and gamble with adults at 0.54 odds.
DISCUSSION
This study systematically examined relationships between adolescent lottery-purchasing and problem-gambling severity, and is among the first to the differences in associations between problem-gambling severity and measures of health and functioning and gambling perceptions and behaviors between lottery-purchasing and non-lottery-purchasing adolescents. Consistent with the first hypothesis, results indicate that lottery-purchasing was associated with ARPG, PG, and GD. In line with the second hypothesis, a greater proportion of adolescents perceived that prevention methods targeting problem gambling were not important. Regarding the third hypothesis, only the relationship between problem-gambling severity and occasional smoking differed by lottery-purchasing status. However, exploratory analyses revealed between-group differences in associations between problem-gambling severity and several gambling characteristics, including bingo gambling, receipt of other lottery products, machine gambling, betting on games of skill, gambling on the internet, gambling onset before age 15, gambling alone, and gambling with friends and with adults.
Associations between lottery-purchasing and permissiveness towards gambling in adolescents are consistent with previous findings on youth perceptions of lottery gambling. Youth who gamble on the lottery begin gambling at earlier ages (12 years of age) despite knowledge of age restrictions, and believe there should be no age restrictions to purchasing lottery tickets (Felsher et al. 2004). Social learning theory proposes that risky behaviors in youth may be learned through modeling of influential figures, including parents, who may facilitate normalization of such behavior (Bandura 1977). Similarly, our results demonstrate that lottery-purchasing was associated with parental approval of gambling, and lottery-purchasing adolescents with ARPG were less likely to initiate gambling after age 15 years. Convergent research has suggested that adolescents with family members who engage in and promote gambling may perceive gambling as acceptable and less harmful, which may contribute to initiation and maintenance of gambling behavior (Gupta and Derevensky 1997; Campbell et al. 2011; Rahman et al. 2014).
Youth with gambling problems have previously reported parent-facilitated gambling, in which parents purchased lottery tickets for their underage children and modeled gambling behaviors (Felsher et al. 2003; Wood and Griffiths 1998; Hardoon and Derevensky 2002). Among different gambling characteristics explored in the current study, between-group differences appeared most robust for the effect of ARPG on having received other lottery tickets (e.g., Powerball, non-instant lottery), though not directly attributed to having received lottery products from parents. Receiving lottery tickets may be initial gambling events during which risky behavior is modeled for youths, and among those who purchased lottery products, may contribute to problematic gambling. Additionally, parental involvement in gambling has been associated with adolescent vulnerability to problem gambling (Hardoon et al. 2004; Zhai et al. 2017). Together with previous evidence, parental gambling and involvement with adolescents’ gambling may be a common link between permissive gambling attitudes and lottery-purchasing in adolescents. Longitudinal studies are important to determine pathways between parent and child lottery gambling, gambling attitudes, and problem gambling.
Results of exploratory analyses demonstrated between-group differences in relationships between ARPG and gambling partners and types. Lottery-purchasing adolescents demonstrated greater associations between ARPG and gambling alone, as well as with machine and internet gambling. The additional lack of associations between ARPG and gambling with friends and adults, in contrast to non-lottery-purchasing adolescents, suggest that asocial and solitary forms of gambling may contribute more saliently to problem gambling within lottery-purchasing adolescents. Though not statistically different between groups, the odds of gambling for social reasons were numerically lower and non-significant within lottery-purchasing adolescents, in contrast to non-lottery-purchasing adolescents, with ARPG. As gambling has been characterized as ‘solitary’ in severe problem-gambling, technology-facilitated gambling, including machine and internet gambling, may increase problem-gambling severity in adolescents through its asocial engagement (Griffiths 1995). Machine and online forms of gambling have been hypothesized to shift adolescents towards asocial gambling, and escalate solitary behavior and isolation (Griffiths 1999, 1995). The extent to which lottery-purchasing and solidary behaviors, including technology-involved gambling, contribute to problem-gambling severity merits further study. Additionally, relationships between lottery-purchasing and gambling involving technology among youth at-risk for problem-gambling may be further investigated in longitudinal studies.
Taken together, results suggest that lottery-purchasing may identify a high-risk group of adolescents with ARPG demarcated by normalized perceptions of gambling as acceptable and asocial gambling behaviors that may include engaging technology to gamble. Critical next-steps for problem-gambling prevention may emphasize enhancing supportive social relationships and education of parents’ to prevent involvement in their children’s early gambling behavior including facilitating lottery-gambling. Problem-gambling assessments may include modalities and types of early gambling behaviors including lottery gambling and machine gambling to explore potential underlying risk factors.
The study should be considered in the context of several limitations. While both purchasing and receiving lottery-tickets were measured, assessments did not include the sequence in which they occurred and from whom lottery tickets were received. However, among the gambling characteristics tested, receiving lottery tickets had the most statistically significant associations with ARPG within lottery-purchasing adolescents, and lottery-gambling behavior portends more severe problem gambling (Stange et al. 2018). Adolescent purchasing of lottery products was considered together. As participants may be unwilling to report sensitive information such as illegal underage lottery-purchasing, the power to resolve interactions with problem-gambling severity may be limited if lottery products were considered separately. Hence, it is thus important for future research to examine differences in gambling problems and maladaptive health and social outcomes associated with use of different lottery products (Short et al. 2015). While measures were not verified by peers and parents, unwillingness to disclose sensitive information may bias data from other reporters. The sample was collected from Connecticut schools, and generalizability to national and international contexts is limited. Furthermore, the cross-sectional data limited resolution of direct and indirect pathways between lottery-gambling, problem-gambling severity, and associated health/functioning measures and gambling characteristics. Longitudinal data may elucidate mechanistic relationships underlying the prevalence of problem-gambling-severity groups within lottery-purchasing youth over time.
This is one of the first studies to demonstrate that lottery-purchasing adolescents had stronger associations between ARPG and technology-facilitated gambling, including machine and online gambling, and gambling alone, and weaker associations between ARPG and peer gambling partners, compared to non-lottery-purchasing adolescents. These findings highlight the need to understand the role of social relationships and family contexts in the etiology of problem gambling among youth who participate in widely available lottery gambling. Additionally, the greater proportions of lottery-purchasing adolescents with problem gambling and parental approval of gambling, as well as stronger associations between ARPG and receiving lottery tickets in lottery-purchasing adolescents reinforce the importance of understanding the link between parental involvement in their children’s gambling and problem-gambling severity in youth. Prevention efforts in schools and communities that facilitate secure relationships between adolescents and parents, educate parents on lottery participation, and protect against solitary behaviors may ameliorate risks of problem gambling.
Supplementary Material
Acknowledgments:
This project was supported by National Institute of Health (grant numbers R01 DA019039 and RL1 AA017539). This work was also supported by the Connecticut Mental Health Center, the Connecticut State Department of Mental Health and Addiction Services, the Connecticut Council on Problem Gambling, and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming. The funding agencies had no role in data collection or analysis or in the decision to submit the paper for publication.
Footnotes
Declaration of Interest: The authors report no conflicts of interest with respect to the content of this manuscript. Dr. Potenza has: consulted for and advised Game Day Data, the Addiction Policy Forum, AXA, Idorsia, and Opiant/Lakelight Therapeutics; received research support from the Veteran’s Administration, Mohegan Sun Casino, and the National Center for Responsible Gaming (no the International Center for Responsible Gambling); participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders or other health topics; consulted for law offices and the federal public defender’s office in issues related to impulse-control and addictive disorders; provided clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; performed grant reviews for the National Institutes of Health and other agencies; edited journals and journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. Other authors report no disclosures. The views presented in this manuscript represent those of the authors and not necessarily those of the funding agencies.
Informed Consent: All participants gave informed consent
Ethical Approval: All procedures performed in human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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