GAMBLING ATTITUDES AND BEHAVIORS IN IOWA MCPGSA 2015 Ki Park, Ph.D.; UNI-CSBR Eric Preuss, MA, IAADC, CCS, LICDC; IDPH
Objectives Understand the key findings of the 2013 Attitudes and Behaviors Report on Iowans Become familiar with the tools used to estimate population prevalence of gambling Identify key implications for prevention, intervention, and treatment services. 2
Do you know the answers about problem gambling in your state? Types and Frequencies of gambling activities? Prevalence of problem gambling? Risk Factors? Co-morbidity? Awareness of treatment services available? Awareness how to access help? 3
Iowa s Gambling History 4
Casino Growth in Iowa 5
Lottery Retailer Locations 6
Iowa Gambling Treatment Program (IGTP) Locations 7
We wanted to know more about gambling in Iowa... Gambling and Problem Gambling in Iowa Studies First statewide survey - 1989 by Rachel A. Volberg, Ph.D. Follow-up survey in 1995 1,500 Respondents (18 and older) Iowa Behavioral Risk Factor Surveillance System (BRFSS) In 2004 three gambling questions added Annual Survey of Iowans 18 and older 5,000 household telephone surveys In 2015 BBGS replaces previous questions and includes a pre-screening question... have you gambled in the past 12 months 8
We wanted to know more about gambling in Iowa... Iowa Youth Survey Biennial Survey of 6 th, 8 th, and 11 th Graders Gambling questions have been part of the survey since 1999 Problem Gambling Questions Report (2012) 2014 report coming soon! College Students (2013) Pilot Study of Gambling Attitudes and Behaviors Among Iowa College Students 9
We wanted to know more about gambling in Iowa... Gambling Attitudes and Behaviors: A 2011 Survey of Adult Iowans Gambling Attitudes and Behaviors: A 2013 Survey of Adult Iowans Planning for 2015/2016 survey Funded by the Iowa Gambling Treatment Program Conducted by UNI CSBR June 25, 2015 Gambling Attitudes and Behaviors in Iowa 10
Gambling Attitudes and Behaviors in Iowa The 2011 Survey 1,700 Respondents Address-based sample/telephone (1,230) and Online (470) The 2013 Survey 1,826 Respondents Dual-frame (land and cell) random digit dial (DFRRD) telephone sampling methodology. 564 landlines and 1,262 cell phone June 25, 2015 Gambling Attitudes and Behaviors in Iowa 11
Gambling Attitudes and Behaviors in Iowa Considerable change in the gambling landscape in last 30 years in Iowa Increase in gambling opportunities 18 licensed Casinos (#19 opens in August) 3 Tribal Casinos 2,400 Lottery outlets Iowa Lottery has been around 30 years (May 1985) 2,600 licensed social gaming events (raffles, bingo, etc.) Numerous Internet, online gaming/gambling, and illegal gaming opportunities June 25, 2015 Gambling Attitudes and Behaviors in Iowa 12
Gambling Attitudes and Behaviors: A 2013 Survey of Adult Iowans June 25, 2015 Gambling Attitudes and Behaviors in Iowa 13
A The Tools Survey Tool Development of Questions It uses multiple sources (US & Canada) NODS -DSM IV screen for Gambling problems Problem Gambling Severity Index (PGSI) Gambling behavior Attitudes questions Length/Time 14
A How Did We Define Gambling? Slot machines, Table games at a casino such as poker, roulette, craps, and blackjack Video poker, video keno, or video blackjack, Dice games, Scratch tickets or pull tabs, Lotteries such as Powerball, Hot Lotto, Mega Millions, and daily numbers, Racetracks (either horses or dogs), Bingo, Bets or wagers on card games with friends, family, or others but not at a casino, 15
A How Did We Define Gambling? Bets or wagers on fantasy sports leagues or games (included only if there was an entry fee to play), Office pools such as college basketball tournaments or delivery dates for babies, Other sports betting on professional, college, and amateur games or events, Raffle tickets including those in support of charitable causes, Online gambling using the Internet, Live keno, Video lottery machines, High-risk trading of stocks, commodities, or futures, and Bets or gambling using some other game, activity, or event not listed. 16
A Overview Adult Iowans Gambled in the past 30 days 46.4% Gambled in the past 12 months 77.8% Never gambled 6.6% Ever gambled 93.4% Methodology The 2013 Survey of Public Attitudes and Behaviors toward Gambling used: Dual-frame (land and cell) random digit dial (DFRRD) telephone sampling A total of 1,826 interviews (564 landlines and 1,262 cellphones) were completed from September 2013 to December 2013. The data was weighted to reflect the state adult (18+years) population 17
A Overview 95% Confidence interval are values above and below the point estimate that indicate with 95% probability the upper and lower range that the true population parameter falls. The confidence interval (CI) is important when comparing the point estimates between 2011 and 2013 data. In this figure the range of CI values is indicated as I at the top of each bar. These small lines are drawn in scale across the report 18
A Overview Population estimates of gambling behavior in Iowa Year Pop Est n Percent SE Percent Lower 95% Upper 95% DEFF Gambled in the past 30 days 2011 965,855 41.90 1.63 38.74 45.14 2013 1,071,060 46.35 1.53 43.36 49.36 1.72 Gambled in the past 12 months 2011 1,588,290 68.91 1.55 65.91 71.86 2013 1,797,220 77.77 1.25 75.22 80.12 1.64 Ever gambled 2011 2,098,351 91.04 0.99 88.89 92.80 2013 2,157,704 93.37 0.81 91.59 94.79 1.94 The Design Effect (DEFF) is a measure to adjust the variance in a cluster sampling design. It inflates the variances to allow a correct estimation of the parameters 19
B Where is the increase? 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 37.90% 32.90% 58.50% 57.80% 52.40% 44.40% 2011-Past 12 months 2013-Past 12 months 20.00% 10.00% 0.00% Casino Lottery Other 20
B Where is the increase? Spending Millions 1,600 1,400 1,200 $1,379.17 $1,465.96 $1,444.21 1,000 800 600 400 200 0 $271.39 $339.25 $310.85 2011 2012 2013 Casinos Lottery 21
C Public Health Approach* At risk gambler No Gambling Healthy Gambling Unhealthy Gambling Treatment Secondary prevention Primary prevention Harm reduction Public Health Interventions *Korn & Shaffer 1999 22
C At risk gambler At risk gambler in the past 12 months Iowa adults Gambled in the past 12 months 16.0% 77.8% Never Gambled 6.6% Most severe classification in NODS or PGSI in the past 12 months 2.0% Ever gambled 93.4% Using the National Opinion Research Center s DSM-IV Screen for Gambling Problems, commonly referred to as the NODS, the prevalence of probable pathological gambling among adult Iowans was 0.9% for lifetime (ever) and 0.4% for the past 12 months. The rates of gambling pathology in the past 12 months in 2013 were not significantly higher than in 2011. It is estimated that more than 8,000 adult Iowans may be classified as pathological gamblers in the past 12 months June 25, 2015 Gambling Attitudes and Behaviors in Iowa 23
C At risk gambler Gambling Activities Aggregated gambling activities (in the past 12 m ) Iowans who gambled & at risk gamblers 24
C At risk gambler Gambling Preferences Preferred gambling activities (in the past 12 m ) Iowans who gambled & at risk gamblers 25
C At risk gambler Gambling Activities Grouping gambling activities (in the past 12 m ) 26
C At risk gambler Year Pop Est n Percent Casino only 2013 172,965 7.48 Lottery only 2013 649,550 28.11 Casino and lottery 2013 703,287 30.43 Casinos only % Lotteries Only % Casinos & lotteries % At risk gamblers Yes 28.8 11.8 30.6 No 71.2 88.2 69.4 27
D Gambling Disorder Year Pop Est n Percent Any NODS or PGSI problem gambling symptoms (at risk) Most severe classification with NODS or PGSI (problem or pathological) 2011 303,315 13.08 2013 369,004 15.97 2011 13,036 0.56 2013 46,307 2.00 28
D Gambling Disorder (cont.) NODS or PGSI most severe classification (problem or pathological gambler) 46,000 11,000 19,000 Self-reported gambling problem For the treatment perspectives, self-awareness of gambling problems is critical to initiate the help seeking. About three-fourths of gamblers who were classified as disordered gamblers did not recognized that they may have gambling problems. June 25, 2015 Gambling Attitudes and Behaviors in Iowa 29
E Seeking Help 30
E Revenue and Funding 31
F Attitude about gambling The harm far outweighs the benefits The harm somewhat outweighs the benefits The benefits are about equal to the harm The benefits somewhat outweigh the harm The benefits far outweigh the harm 29.3% 26.4% 29.9% 9.8% 4.7% 0% 20% 40% 60% 80% 100% 32
G Social impact circles Others They Know Personally Friends and Coworkers Family 29.8% 17.7% Know a person whose gambling may be causing [ ] problems Negatively affected by others gambling behaviors (aggregated estimate) Problem Gambler 33
H Awareness of BETS OFF & Treatment Almost 9 in 10 adult Iowans (89.4%) said they are aware of the gambling helpline 1-800-BETS OFF. However, only 44.1% were aware that Iowa has publicly-funded gambling treatment services. 34
I Comorbid conditions Yes No Tobacco Alcohol Became intoxicated with alcohol Illegal drugs Misuse of prescription and over the counter medication 30.3% 55.9% 20.8% 2.2% 2.6% 69.7% 44.1% 71.0% 97.8% 97.4% Mental health was NOT good 40.4% 59.6% 0% 20% 40% 60% 80% 100% 35
I Self-reported Problems Tobacco 30.2% Alcohol 5.9% Illegal drugs Misuse of prescription and over the counter medication Gambling 3.1% 3.0% 2.6% Over the counter medication 1.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 36
J Prevalence of Gambling (12 M) Male Female 18-34 years 35-49 years 50-64 years 65 years or more HS, GED or Less College 1-3 years College 4 years or more Less than $25,000 $25,000 to $49,999 $50,000 to $74,999 $75,000 or more White (non-hispanic) All other Married Divorced or separated Widowed Never married 81.5% 74.3% 80.0% 83.3% 78.5% 68.3% 76.0% 79.1% 78.6% 70.6% 81.7% 78.4% 86.8% 78.7% 68.7% 78.4% 82.6% 66.3% 75.8% Live on a farm or in a small town of Live in a large town of 5,000 to less Live in a city of 25,000 to less than In a city of 50,000 or more 78.2% 72.7% 82.3% 78.3% 30% 40% 50% 60% 70% 80% 90% 100% 37
J Ever heard or seen 1-800-BETS OFF Male Female 18-34 years 35-49 years 50-64 years 65 years or more HS, GED or Less College 1-3 years College 4 years or more Less than $25,000 $25,000 to $49,999 $50,000 to $74,999 $75,000 or more White (non-hispanic) All other Married Divorced or separated Widowed Never married 91.2% 87.7% 87.9% 94.7% 94.7% 77.7% 85.1% 92.2% 91.8% 81.5% 91.6% 95.9% 95.2% 90.6% 75.6% 91.7% 89.9% 68.3% 87.1% Live on a farm or in a small town of less Live in a large town of 5,000 to less than Live in a city of 25,000 to less than 50,000 In a city of 50,000 or more 88.5% 87.7% 90.1% 92.2% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 38
K Multivariable analysis: Gambling 12 m 39
K Multivariable analysis: At risk 40
K Multivariable analysis: Awareness State funded 41
Gambling Attitudes and Behaviors Distance-access-proximity Internet Limitations Full report is available at: https://www.idph.state.ia.us/igtp/reports.aspx 42
Implications for Prevention Adult and Youth Data Available Resource for development of focused prevention work plans Statewide impact of problem gambling Credibility of need for Prevention Efforts Access to Trend Analysis Gambling Behaviors Gambling Attitudes Impact of new forms of gambling/gaming Impact of Prevention Efforts Data Driven Strategies Best Guess about Effect 43
Implications for Prevention Integrated Prevention Services Behavioral Health (SUDs/MH/PG) Primary Care Criminal Justice Community Organizations Youth, Adolescent, College, Adult Matching Curriculum to Audience Stacked Deck Money Smart ISAIC Lending Library Quarterly Prevention Round Table Calls Statewide consistency of message Successes & Pilot projects Strategic Prevention Framework Meaningful Use of the data Awareness Stigma 44
Implications for Prevention Targeted Health Promotion Activities Radio Online Billboards Television You Tube Other social media Collaborative Efforts Iowa Lottery and Iowa Gaming Association NPGAM/RGEW Access to message Lack of Awareness 45
Implications for Prevention Link between health promotion expenditures and those who seek help? $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 Health Promotion Spending and IGTP Activity 900 800 700 600 500 400 300 200 100 $0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Health Promotion $'s Placement Screenings Admissions 0 46
Implications for Prevention Link between health promotion expenditures and those who seek help? $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 Health Promotion Spending and BETS OFF Activity 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 $0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 0 Health Promotion $'s Help Line Calls Help Line Referrals 47
Implications for Intervention Targeted Populations At risk gamblers (369,000 Adult Iowans) Problem Gamblers (up to 43,000 Adult Iowans) Disordered Gamblers (up to 8,000 Adult Iowans) Concerned Persons (1 in 5 Iowans affected by PG) Youth (26.7% have gambled) Awareness Stigma 48
Implications for Intervention Information and Referral 1-800-BETS OFF and www.1800betsoff.org Live Chat Warm Hand Offs Junk Calls Dropped Calls SBIRT PG Project fall of 2015 National Guard Camp Dodge Access to Help Barriers 49
Implications for Treatment No Wrong Door Be Welcoming! link to appropriate services Mental Health Substance Use Disorder (including Tobacco) Community Supports Primary Care Annual Walk-Throughs (NIATx) Service Delivery Family Members & Concerned Persons Crisis and Informational Services Distance Treatment Services (e-therapy) Recovery Support Services Building of Support Networks Embrace Technology Engagement and Continuation Barriers to Help 50
QUESTIONS? Ki Park Center for Social and Behavioral Research ki.park@uni.edu 319.273.3114 Eric M Preuss Iowa Gambling Treatment Program eric.preuss@idph.iowa.gov 515.281.8802 Gambling Attitudes and Behaviors in Iowa