FLAGS (EGM) Preliminary Results of Phase IV: development of the FocaL Adult Gambling Screen

Transcription

1 FLAGS (EGM) Preliminary Results of Phase IV: development of the FocaL Adult Gambling Screen Tony Schellinck, Focal Research and Dalhousie University Tracy Schrans, President of Focal Research Michael Bliemel, Dalhousie University Heather Schellinck, Dalhousie University 8th European Conference on Gambling Studies and Policy Issues Sept 2010 Research funded by Ontario Problem Gambling Research Centre still under review 1

2 Our Vision FLAGS (EGM) is the next generation of measurement for adult gambling risk and harm specifically designed for public health surveillance. FLAGS moves beyond traditional identification of problem gambling prevalence providing information for use in informing, monitoring and evaluating gambling related prevention, harm reduction, social policy and public health policy for youth. 2

3 Our Purpose: Public Health Surveillance According to the World Health Organization (WHO) Public Health Surveillance is the ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice The primary goals of surveillance as defined by WHO are: To serve as an early warning system - measure risk Guide public health policy and strategies Provide actionable information Document the impact of an intervention or progress towards specified public health targets/goals Be highly accurate and consistent Understand and monitor the epidemiology of a condition in order to set priorities and guide public health policy and strategies be causally related and detailed enough for policy development 3

4 Why is FLAGS (EGM) needed? Current screens are probably reasonably accurate in identifying adults who are suffering more severely from the effects of gambling. However, these instruments were not designed to identify gamblers who may be at different risk levels or to provide detailed information to the decision maker. Moreover, the goal is to use surveillance to inform, monitor and evaluate it is equally important to know why a person is at risk especially if the goal is to help them. FLAGS is designed to do just that. FLAGS also more accurately assigns adults to a problem gambling category as it has a larger inventory of consequences than other screens as well as a measure of persistence that helps to overcome the transient nature of adult behaviour and properly define a problem gambler. Because all of the constructs are multi-item measures that are reliable and valid, the FLAGS instrument allows for accurate comparisons among jurisdictions of the prevalence of problem gambling and perhaps more importantly the extent to which the existing adult populations are at risk of developing problem gambling. 4

5 What is the FocaL Adult Gambling Screen (FLAGS)? FLAGS (EGM) is a new survey instrument designed to gather adult EGM gambling information in order to inform social and public health policy. 58 statements Ten Constructs that provide indications of risk or problem gambling A scoring system that allots people to one of five categories based their being flagged on a combination of indicators A reporting system - set of predesigned analyses that will provide information necessary for decision makers Validity and reliability checks of the constructs and their relationships in the setting it was administered The prevalence and profiles of the each risk category 5

6 FLAGS Five Levels of Player Risk for Machine Gambling Risk Level Label Description Level V Problem Gambler A Problem Gambler is a person who flagged as exhibiting both Negative Consequences and Persistence. Level IV Level III Level II Advanced Risk Intermediate Risk Early Risk Those at Advanced Risk are not flagged as a problem gambler but have one or more indications on the five constructs ranked highest in the hierarchy score: Impaired Control: Begin, Preoccupation: Obsessed, Risky Practices: Later, Negative Consequences and Persistence. Those at Intermediate Risk are not Problem or Advanced Risk gamblers, but have been flagged on one or more of the intermediate risk constructs: Impaired Control: Continue and Risky Practices: Earlier. Those at Early Risk have flagged on at least one of Risky Cognitions: Beliefs, Risky Cognitions: Motives or Preoccupation: Desire. Level I No Risk Those at No Risk do not flag on any of the risk indicators although it is possible that they answered yes to one or more statements making up some of the constructs. Level 0 Non-gambler A Non-Gambler by definition is at no-risk because they are not involved in the activity over the last year. 6

7 How was the FLAGS developed and tested? Built on earlier work, 1998 NS VLT study, 2000 Follow-up study, SAPGS development for the Victoria Gambling Research Panel (2004) and the quantitative testing phase for the Victoria Department of Justice (2006). Phase I literature review of method bias in measures funded by OPGRC Phase II Literature review of Formative versus Reflective constructs funded by OPGRC Phase III qualitative and preliminary quantitative research on 190 statements and constructs that were eventually rejected (e.g., superstitions) with 63 casino gamblers in Ontario 2008 funded by OPGRC Phase IV quantitative analysis of responses to 132 statements to formulate FLAGS (EGM) beta 384 Ontario Casino Gamblers Funded by OPGRC Phase V Further quantitative refinement of instrument and testing on VLT gamblers 500 VLT gamblers funded by Nova Scotia Gambling Foundation report due End of September

8 Preoccupation: Desire Reflective Impaired Control: Continue Reflective Formative and Reflective Constructs: FLAGS Impaired Control: Begin Reflective Negative Consequences Formative Risky Practices: Earlier Formative Risky Practices: Later Formative Risky Cognitions: Motives Formative Risky Cognitions: Beliefs Formative Preoccupation: Obsession Reflective Persistence Reflective 8

9 Preoccupation: Desire Impaired Control: Continue PLS Model of FLAGS Coefficients, t scores and construct variance explained Risky Practices: Earlier Impaired Control: Begin Risky Practices: Later Negative Consequences Risky Cognitions: Motives Risky Cognitions: Beliefs Preoccupation: Obsession Persistence

10 Early Risk Constructs Preoccupation: Desire Reflective Impaired Control: Continue Reflective Intermediate Risk Constructs Risk Category Assignment: FLAGS Advanced Risk Constructs Impaired Control: Begin Reflective Problem Gambler Negative Consequences Formative Risky Practices: Earlier Formative Risky Practices: Later Formative Risky Cognitions: Motives Formative Risky Cognitions: Beliefs Formative Preoccupation: Obsession Reflective Persistence Reflective 10

11 Median Hierarchy ranking of Constructs Measure developed based on Toce-Gerstein, et al. (2003) Median Hierarchy Constructs Ranking Risky Cognitions: Beliefs 20 Preoccupation: Desire 28 Risky Practices: Earlier 45.5 Impaired Control: Continue 59 Risky Cognitions: Motives (Money and Depression) 63.5 Preoccupation: Obsessed 85 Impaired Control: Begin 104 Risky Practices: Later 103 Persistence Negative Consequences 114 Early Risk Constructs Intermediate Risk Constructs Advanced Risk Constructs Problem Gambler Constructs 11

12 Risk Profile by Risk Category Constructs All Gamblers No Risk Early Risk Intermediate Risk Advanced Risk Problem Gambler Persistence 11.0% 0.0% 0.0% 0.0% 33.3% 100% Negative Consequences 9.9% 0.0% 0.0% 0.0% 22.2% 100% Preoccupation: Obsession 3.7% 0.0% 0.0% 0.0% 14.3% 41.4% Impaired Control: Begin 8.6% 0.0% 0.0% 0.0% 36.1% 65.5% Risky Practices: Later 12.8% 0.0% 0.0%% 0.0% 66.7% 82.8% Impaired Control: Continue 23.5% 0.0% 0.0% 77.3% 69.4% 100.0% Risky Practices: Earlier 17.9% 0.0% 0.0% 47.7% 55.6% 89.7% Risky Cognitions: Motives 17.1% 0.0% 43.6% 20.5% 38.9% 82.8% Preoccupation: Desire 18.4% 0.0% 28.2% 45.5% 55.6% 62.1% Risky Cognitions: Beliefs 8.8% 0.0% 35.9% 4.5% 22.2% 31.0% 12

13 Risk Profile by Risk Category Constructs All Gamblers No Risk Early Risk Intermediate Risk Advanced Risk Problem Gambler Persistence 11.0% 0.0% 0.0% 0.0% 33.3% 100% Negative Consequences 9.9% 0.0% 0.0% 0.0% 22.2% 100% Preoccupation: Obsession 3.7% 0.0% 0.0% 0.0% 14.3% 41.4% Impaired Control: Begin 8.6% 0.0% 0.0% 0.0% 36.1% 65.5% Risky Practices: Later 12.8% 0.0% 0.0%% 0.0% 66.7% 82.8% Impaired Control: Continue 23.5% 0.0% 0.0% 77.3% 69.4% 100.0% Risky Practices: Earlier 17.9% 0.0% 0.0% 47.7% 55.6% 89.7% Risky Cognitions: Motives 17.1% 0.0% 43.6% 20.5% 38.9% 82.8% Preoccupation: Desire 18.4% 0.0% 28.2% 45.5% 55.6% 62.1% Risky Cognitions: Beliefs 8.8% 0.0% 35.9% 4.5% 22.2% 31.0% 13

14 PGSI Categories Comparison to PGSI FLAGS Categories No Risk Early Risk Inter-mediate Risk Advanced Risk Problem Gambler Total No Risk 47.1% 6.4% 0.8% 0.5% 0.0% 54.8% Low Risk 11.2% 2.4% 4.3% 1.1% 0.3% 19.3% Medium Risk 2.1% 1.6% 6.7% 7.2% 2.7% 20.3% Problem Gambler 0.0% 0.0% 0.0% 0.8% 4.8% 5.6% Total 60.4% 10.4% 11.8% 9.6% 7.8% 100.0% Overall the FLAGS categories correlation with the PGSI categories (Spearman=0.730). Risk category only correlation is (n= 345). If it is assumed that the FLAGS Intermediate and Advanced Risk segments are roughly equivalent to the PGSI Moderate Risk there was 68.2% agreement. For those classified at some level of risk (excluding Problem Gambler) by either instrument the two instruments agreed on only 39.9% of the cases. 14

15 What are the next steps? FLAGS Focal has completed a survey of 500 regular VLT gamblers in Nova Scotia for the Nova Scotia Gambling Foundation. These data have provided further testing of the FLAGS instruments on a different population and a different form of EGM gambling. The general report should be released by the end of this month. A detailed report focus on FLAGS will follow. 15

16 Cut-Offs Chosen for Indicators Based on ROC Analysis Construct Number of Statements Cut-Off Chosen Number Statements Tested FLAGS II Persistence Negative Consequences Preoccupation: Obsession Impaired Control: Begin Risky Practices: Later Risky Practices: Earlier Impaired Control: Continue Preoccupation: Desire Risky Cognitions: Motives Risky Cognitions: Beliefs Total

17 Impaired Control Begin Comp. 2 Loading Frequen cy Hier. Rank Corr with PGSI Impaired Control Continue Comp. 1 Loading Frequen cy Hier. Rank Corr with PGSI Construct and Statements I often spend more money gambling than I intended. Even when I intend to spend a few dollars gambling, I often end up spending much more. I sometimes gamble with money that I can t really afford to lose. Once I have started gambling on the slots I find it very hard to stop. I often spend more time gambling than I intend to % % % % % Construct and Statements I have tried to cut back on my slots play with little success. I have tried unsuccessfully to stop or reduce my gambling on the slots. There have been times I have gambled despite my desire not to % % %

18 Preoccupation Desire Preoccupation: Obsessed Impaired Control: Continue Impaired Control: Begin Persistence Risky Cognitions: Beliefs Risky Cognitions: Motives Risky Practices: Earlier Risky Practices: Later Negative Consequences Discriminant Validity among Reflective Constructs: Gefen and Straub (2005) compared the correlations between the individual items and the PLS calculated construct scores as listed with the individual items. Min 0.10 diff needed. Constructs Statements IC-cont IC-cont IC-cont IC-cont IC-cont IC-begin IC-begin IC-begin Persist Persist Persist Persist

19 Erroneous Cognitions: Beliefs Preoccupation Desire Risky Practices: Earlier Impaired Control: Continue Erroneous Cognitions: Motives Preoccupation: Obsessed Impaired Control: Begin Risky Practices: Later Negative Consequences Persistence Square Root of AVE and Inter-construct Correlations to Test for Divergent Validity (Compeau et al. 1999). Adequate discriminant validity is indicated if the square root of the construct s AVE is greater than its correlations with the other constructs. Erroneous Cognitions: Beliefs n.a. Preoccupation Desire Risky Practices: Earlier n.a. Impaired Control: Continue Erroneous Cognitions: Motives n.a. Preoccupation: Obsessed Impaired Control: Begin Risky Practices: Later n.a. Negative Consequences n.a. Persistence Focal Research

20 Measures of Internal Consistency Erroneous Cognitions: Beliefs (Formative) Erroneous Cognitions: Motives (Formative) Average Variance Extracted (AVE) Composite Reliability Average Communality na na 0.31 na na 0.49 Preoccupation Desire (Reflective) Preoccupation: Obsessed (Reflective) Impaired Control: Begin (Reflective) Impaired Control: Continue (Reflective) Formative Constructs Risky Practices: Earlier (Formative) na na 0.40 Risky Practices: Later (Formative) na na 0.51 Negative Consequences (Formative) na na 0.41 Persistence (Reflective)

21 Sample Formative Constructs: Risky Practices Early and Later Risky Practices Early Statement Heirarchy Frequency Rank R PGSI VIF I sometimes exceed the amount of money I intended to spend in order to win back money I have lost. 29.7% When gambling on the slots I usually use my bank or debit card to get more money so I can keep playing. 19.8% I play max bet if I m on a winning streak. 29.7% If I win big I am likely to put the money back into a machine and keep playing. 17.6% When gambling on a slot machine I usually play as fast as I can. 15.0% I have sometimes gambled for more than six hours straight when I was playing the slots. 34.8% Risky Practices Later Statement Heirarchy Frequency Rank R PGSI VIF After losing more money than I wanted on the slots I usually try to win it back by playing again either later that day or on another day. 14.7% When gambling on the slots I usually use my credit card to get more money so I can keep playing. 10.7% When I gamble with friends or family I sometimes stay and continue to play after they have stopped or left. 8.0% I have sometimes borrowed money from others so I could go and gamble on the slots. 4.3% I have borrowed money from other people at the casino in order to continue gambling. 4.0% I have left the casino to get more money so I can come back and keep on gambling. 7.8%

22 Sensitivity ROC for Negative Consequences using PGSI Score 8+ for State Variable Value Specificity

23 Coordinates of the Curve for Consequences and PGSI 8+ Positive if Greater Than or Equal To Sensitivity (Proportion) 1 Specificity (Proportion)

24 FLAGS (EGM) Preliminary Results of Phase IV: development of the FocaL Adult Gambling Screen Tony Schellinck, Focal Research and Dalhousie University Tracy Schrans, President of Focal Research Michael Bliemel, Dalhousie University Heather Schellinck, Dalhousie University Research funded by Ontario Problem Gambling Research Centre still under review 24