The relationship between player losses and gambling-related harm: evidence from nationally representative cross-sectional surveys in four countries

Background and AimsFlaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. DesignFour cross-sectional surveys. SettingNationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). ParticipantsA total of 10632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74years in Finland and 5235 people aged 15-74years in Norway. MeasurementsProblem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. FindingsRisk curves for total gambling losses were estimated to be r-shaped in Australia { losses=4.7 [95% confidence interval (CI)=3.8, 6.5], losses(2=)-7.6 (95% CI=-17.5, -4.5)}, Canada [ losses=2.0 (95% CI=1.3, 3.9), losses(2=)-3.9 (95% CI=-15.4, -2.2)] and Finland [ losses=3.6 (95% CI=2.5, 7.5), losses(2=)-4.4 (95% CI=-34.9, -2.4)] and linear in Norway [ losses=1.6 (95% CI=0.6, 3.1), losses(2=)-2.6 (95% CI=-12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. ConclusionsPlayer loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm.