The relationship between age of gambling onset and adolescent problematic gambling severity

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Abstract

The aim of this study was to characterize the association between problem gambling severity and multiple health, functioning and gambling variables in adolescents aged 13–18 stratified by age of gambling onset. Survey data in 1624 Connecticut high school students stratified by age of gambling onset (≤11 years vs. ≥ 12 years) were analyzed in descriptive analyses and in logistic regression models. Earlier age of onset was associated with problem gambling severity as indexed by a higher frequency of at-risk/problem gambling (ARPG). Most health, functioning and gambling measures were similarly associated with problem gambling severity in the earlier- and later-age-of-gambling-onset groups with the exception of participation in non-strategic forms of gambling, which was more strongly associated with ARPG in the earlier-onset (OR = 1.74, 95%CI = [1.26, 2.39]) as compared to later-onset (OR = 0.94, 95%CI = [0.60, 1.48]) group (Interaction OR = 1.91, 95%CI = [1.18, 3.26]). Post-hoc analysis revealed that earlier-onset ARPG was more strongly associated with multiple forms of non-strategic gambling including lottery (instant, traditional) and slot-machine gambling. The finding that problem gambling severity is more closely associated with multiple non-strategic forms of gambling amongst youth with earlier-onset gambling highlights the relevance of these types of youth gambling. The extent to which non-strategic forms of gambling may serve as a gateway to other forms of gambling or risk behaviors warrants additional study, and efforts targeting youth gambling should consider how best to address non-strategic gambling through education, prevention, treatment and policy efforts.

Introduction

Gambling is common with over two-thirds of the U.S. adult population having gambled in the past year (Lynch et al., 2004; Potenza et al., 2001a). Most adults gamble without problems, although an estimated 12 million individuals experience either problematic or pathological gambling (PPG; Lynch et al., 2004). Adult PPG has been associated with substance use problems, legal troubles, and poor physical and mental health (Barry et al., 2011; Potenza et al., 2001a; Shaffer and Korn, 2002; Toneatto and Wang, 2009).

Most adults with PPG begin gambling prior to adulthood (Lynch et al., 2004; Volberg, 1994). Recent research demonstrates that the prevalence of past-year gambling among adolescents is 50%–90% (Gupta and Derevensky, 2000; Shaffer and Hall, 2001). Multiple factors (risk taking propensities during adolescence, accessibility, social acceptance) may influence adolescent gambling tendencies (Lloyd et al., 2010; Wilber and Potenza, 2006). Adolescence is a developmental period marked by high impulsivity, risk taking, and vulnerability to addiction, all of which can persist into adulthood (Auger et al., 2010; Chambers et al., 2003; Van Leijenhorst et al., 2010; Volberg, 1994). Consistently, when compared to adult populations, adolescents may be two to four times more likely to experience gambling problems (Burge et al., 2006; Wilber and Potenza, 2006).

PPG appears heterogeneous (Blaszczynski and Nower, 2002; Jimenez-Murcia et al., 2010; Ledgerwood and Petry, 2006). From a clinical perspective, identifying subgroups based on distinguishing characteristics may aid in advancing prevention and treatment strategies. Age of gambling onset may represent an important distinguishing feature in PPG as in substance use disorders. Early age of onset of alcohol use has been linked to later-life substance use, other risk behaviors and adverse measures of life functioning (Chou and Pickering, 1992; DeWit et al., 2000; Grant and Dawson, 1997; Hawkins et al., 1997; Hingson et al., 2006). Similarly, early age at gambling onset may be predictive of future problems as it associates with adult problems including substance use disorders, depression and other psychiatric concerns (Grant et al., 2009; Jimenez-Murcia et al., 2010; Lynch et al., 2004). In another study, early onset adult PPG was associated with suicidal ideation, early onset of alcohol use, and prior substance abuse treatment (Burge et al., 2006). Together, these findings highlight the importance of examining the age of gambling onset in relation to gambling characteristics and psychiatric outcomes.

To date, few studies have focused on the relationship between age of gambling onset and the psychiatric profile of adolescents (13–18 years) with respect to their age at gambling onset. Felsher et al. (2004) studied gambling behaviors in a sample of Canadian adolescents (10–18 years) and found that compared to individuals who did not engage in lottery gambling, those who did reported a younger age of onset for gambling behaviors. A longitudinal study which examined a large sample of Canadian adolescents (11–16 years) showed that earlier- and later-onset gamblers followed different developmental trajectories and suggested that prevention strategies should be specific to each group (Vitaro et al., 2004). As earlier-onset gambling has been linked to lottery gambling, a non-strategic form of gambling, the extent to which this type of gambling may associate to risky or problematic gambling in youth warrants further investigation. A recent study showed that early age of gambling onset was associated with at-risk/problem gambling (ARPG) in adolescent Internet gamblers (Potenza et al., 2011). In this study, a lower threshold for problem gambling severity (individuals reporting or one or more inclusionary criteria for pathological gambling) was employed to examine gambling behaviors. This threshold was selected given findings that less severe forms of problem gambling during adolescence to be associated with poorer functioning during adolescence as well as in adulthood (Desai et al., 2005; Duhig et al., 2007; Lynch et al., 2004; Pantalon et al., 2008). To better understand and characterize adolescent PPG is crucial as it may be the most opportune time to prevent further development of the pathology (Wilber and Potenza, 2006).

The aim of this study was to investigate health, functioning and gambling measures associated with problem gambling severity in adolescents stratified by earlier (≤11 years) and later (≥12 years) age of gambling onset. To examine these questions, we utilized data from a cross-sectional survey that assessed risk behaviors in Connecticut high school students; these data have been used previously to investigate correlates of problem gambling severity in general (Yip et al., 2011) and amongst internet and non-internet gamblers (Potenza et al., 2011). However, prior research with these data did not consider age of onset of gambling behavior in relation to health, functioning, and gambling measures.

We hypothesized that the prevalence of ARPG would be greater among adolescents who reported an earlier-onset of gambling. Furthermore, we hypothesized that problem gambling severity would be more strongly associated with poorer academic performance, substance use, depression, and aggression in early onset gamblers, compared to late onset gamblers. Given prior findings linking early age of gambling onset with lottery gambling (Felsher et al., 2004), we also hypothesized that problem gambling severity would be more strongly associated with non-strategic forms of gambling amongst earlier-onset as compared to later-onset gamblers.

Section snippets

Participants

The recruitment and description of participants are as previously described (Cavallo et al., 2010; Desai et al., 2010; Grant et al., 2011a, Grant et al., 2011b; Liu et al., 2011; Schepis et al., 2008, Schepis et al., 2011; Yip et al., 2011). Briefly, all 4-year and non-vocational or special education high schools in the state of Connecticut were invited to participate. Schools were offered an assessment of the risk behaviors associated with their respective student bodies as incentive for

Demographics

Of the 1624 adolescents studied, 1116 (69%) indicated an earlier (prior to 12 years) age of gambling onset (Table 1). Among the earlier-onset gamblers, 43% were classified as ARPG while 57% were classified as LRG. For later-onset gamblers, 32% were classified as ARPG while 68% were classified as LRG, generating a significant between-group difference (χ2(1, N = 1624) = 16.59, p < .0001).

Health and well-being measures

Chi-square (Table S1) and logistic regression (Table 2) analyses examining the relationships between problem

Summary of study

This study examined the correlates of ARPG as related to age of gambling onset amongst a sample of adolescents. Importantly, many youth (close to 70%) report an age of gambling onset prior to age 12. Previous research indicates that there are clinical differences in earlier- and later-onset pathological gamblers, with earlier-onset gamblers exhibiting a more severe psychiatric profile (Burge et al., 2006; Grant et al., 2009; Jimenez-Murcia et al., 2010; Lynch et al., 2004). These associations

Limitations and conclusion

Limitations exist in this study. First, while ecologically valid, the sample was not random. Some DRGs were selected in order to get a more representative sample of the state. Second, the cross-sectional design limits the ability to observe how variables may change throughout adolescence and into adulthood, or from childhood to adolescence. It has been suggested that some variables like gambling type are “developmentally progressive”, meaning that as individuals grow older, their gambling

Role of the funding source

This work was supported in part by the NIH (R01 DA 019039, P50 AA15632, P50 DA09241), the Connecticut State Department of Mental Health and Addictions Services, The Connection, the Yale Gambling Center of Research Excellence Award from the National Center for Responsible Gaming and its Institute for Research on Gambling Disorders, and an unrestricted gift from the Mohegan Sun casino. The funding agencies did not provide input or comment on the content of the manuscript, and the content of the

Contributors

Drs. Desai, Krishnan-Sarin and Potenza were responsible for participant recruitment, data collection, and managing the experimental design of this study. Dr. Marvin Steinberg provided input on the study questionnaire. Drs. Pilver and Desai designed and conducted data analyses. Mr. Rahman, with Dr. Potenza's assistance, conducted literature searches and wrote the first draft of the manuscript, including abstract, introduction, methods, results, and discussion. All authors, including Dr. Rugle,

Conflict of interest

Dr. Potenza has served as a consultant or advisor to Boehringer Ingelheim, Somaxon, various law offices, and the federal defender's office in issues related to impulse control disorders. He has financial interests in Somaxon. He has received research support from the National Institutes of Health, Veteran's Administration, Mohegan Sun Casino, the National Center for Responsible Gaming and its affiliated Institute for Research on Gambling Disorders, Psyadon, Forest Laboratories, Ortho-McNeil,

Acknowledgments

We would like to thank Dr. Helena Rutherford for her input on portions of the first draft of this manuscript. We would also like to thank the survey participants and the members of the research group who collected the data.

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