Bakgrund: Trots att spel har positiva effekter på majoriteten av alla spelare har en till fem procent av befolkningen i varje land runtom i världen spelproblem. Detta folkhälsoproblem medför hälsomässiga, ekonomiska och/eller sociala negativa konsekvenser. I Sverige utgör främst män med låg utbildning och inkomst i åldersgruppen 18-24 år riskgruppen. Ett skäl till varför problemspelandet ökat på senare år är att allt fler spelare väljer internet som spelplattform där de flesta av problemspelarna befinner sig. Motiverande samtal och kognitiv beteendeterapi är två metoder som använts vid preventiva åtgärder mot spelproblem. Syftet med studien var att beskriva motiven till varför människor spelar om pengar på internet samt undersöka skillnaderna i motiv mellan problemspelare och icke-problemspelare. Metod: En litteraturstudie genomfördes och tio vetenskapliga artiklar hittades i databaserna Pubmed, PsycINFO, Academic Search Elite och SciVerse Science Direct. Data bearbetades genom temaanalys. Resultatet visade att spelandets ekonomiska möjligheter, chans till anonymitet, kontroll över sociala interaktioner, bekvämlighet och flexibilitet i spelandet, emotionella tillstånd styr spelandet samt omgivningens påverkan utgjorde sex teman som beskrev motiven till spel om pengar på internet. Problemspelare beskrev i större utsträckning spelandets ekonomiska möjligheter, negativa emotionella tillstånd styr spelandet och chans till anonymitet som viktigaste motiven jämfört med icke-problemspelare som beskrev bekvämlighet och flexibilitet i spelandet och att positiva emotionella tillstånd styr spelandet som viktiga motiv. Implikation: Då spel om pengar på internet är ett relativt nytt fenomen som fortsätter att växa behövs vidare forskning som tydliggör om motiven skiljer sig åt hos specifika grupper i samhället med syfte att individanpassa interventionsprogram. / Background: Although gambling has positive outcomes on the majority of the gamblers, one to five percent of the populations in each country around the world are problem gamblers. This public health issue gives healthy, economics and/or social negative consequences. The Swedish group with most risk for problem gambling is men with low education and income between the years 18-24. One reason to the progress of problem gambling is that more and more players choose Internet, where most problem gamblers exist. Motivational Interviewing and cognitive behavioral therapy are two methods which have been used as preventive measures against problem gambling. The aim of this study was to describe Internet gambling motives and examine differences in motives among problem gamblers and non-problem gamblers. Method: A literature review was made and ten peer reviewed articles was found in the databases Pubmed, PsycINFO, Academic Search Elite and SciVerse Science Direct. Data was processed through theme-analyze. The result showed that economic opportunities, chance to be anonymous, control of social interactions, convenience and flexibility in gambling, emotional state control gambling and the surrounding context as motive formed six themes in which the motives for gambling on Internet are presented. Problem gamblers were more likely to report economic opportunities, negative emotional state control gambling and chance to be anonymous as special important motives than non-problem gamblers, who preferred convenience and flexibility and positive emotional state control gambling as important motives. Implication: Internet gambling is a relatively new phenomenon which continues to grow; more research about differences in motives between specifically populations is needed to make it easier to create intervention programs which match each problem gambler.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

Protective factors against problem gambling are important to study, and this thesis focuses on religious affiliation and family solidarity. In this study, 100 Métis Ontarians aged 46-88 completed a cross-sectional survey. The relationships of problem gambling risk with alcohol misuse, age, gender, religious affiliation, and family solidarity were explored. Intergenerational religious concordance (passing down religious affiliation through generations) was examined in the context of healthy family functioning. A qualitative research question asked participants about the potential relationship between religious beliefs and gambling behaviour. Participants at moderate or high risk of problem gambling (score of two or more on the Problem Gambling Severity Index) were more likely than those at no or low risk to say that they perceive a relationship between their gambling behaviour and their religious beliefs. / Canadian Institutes of Health Research, Ontario Problem Gambling Research Centre

Prevalence studies around the world show that men are the largest group at risk of becoming problem gamblers and that men gamble more than women. However, gambling research has long been gender blind. The gambling market is rapidly changing, with the Internet making gambling more accessible. Further, despite the well-documented presence of health, social and financial problems among the concerned significant others (CSOs) of someone close with gambling problems in clinical and help-seeking samples, there is little research investigating on this population. This thesis aims to examine the relation between gender and problem gambling among regular gamblers and CSOs, and to determine whether there was a convergence of men’s and women’s gambling behavior between 1997/98 and 2009/10 in Sweden. A further aim is to examine health problems associated with Internet gambling and CSOs. The data collections were taken from three different but linked gambling and health representative national population based studies in Sweden, all using the same methods: telephone interviews supplemented by questionnaires. The studies are as follows: 1) prevalence study 1997/98, age 15-74 years, n = 10,000, response rate 72% (n = 7,139) 2) prevalence study 2008/09, age 16-84 years, n = 15,000, response rate 63% (n = 8,165); and 3) incident study 2009/10, the 8,165 participants from the 2008/09 prevalence study were contacted again, response rate 74% (n = 6,021). Gambling was generally merged into domains based on the axis chance-strategy and public-domestic. The dichotomy of public and private spheres is relevant in since there is a link between the public sphere and notions of masculinity and a link between the private and femininity. Further, the literature suggests that men are attracted to gambling that involves features of strategy, whereas women generally prefer game of chance. Problem gambling was measured using SOGS-R and PGSI. Health variables included measures such as self-reported health, psychological stress, social support, alcohol consumption, and financial situation as a determinant of health. There were very few indications of a convergence between men’s and women’s gambling behavior. Men and women generally gambled in different domains. Men gambled more than women and dominated all domains except the domain of chance-domestic, a domain associated with less risk and Internet gambling. However, men and women who gambled regularly were just as likely to be problem gamblers. No gender differences were found in the score from separate PGSI analyses in the chance-public domain (games of chance in public spaces, such as gambling machines and bingo in halls). This domain was also the only domain associated with problem gambling for women who gambled regularly. Men and women were just as likely to report that they were CSOs and they constituted a large proportion of the Swedish population (18%). CSOs experienced a range of social, economic and health related problems including psychological stress, risky alcohol consumption, exposure to violence, and separations. For women who were CSOs, no relation with own problem gambling was found. This thesis suggests that the presence of gambling machines must be addressed to prevent problem gambling and that separate analyses for men and women are required to identify important differences between genders. The findings indicate that gambling domains produce and reinforce gender. Further, to be able to prevent problem gambling we require further knowledge about these gendered processes. However, it is also important to see the overall similarities between men and women to avoid reinforcing stereotypical images of gender which would have an negative impact on the preventive work. Male and female gamblers are both very heterogeneous categories where the specific gambling site, context and life circumstances must be acknowledged. Prevention, research and interventions should also target CSOs if a public health approach is applied because they require help and support in their own right. CSOs also play an important to the problem gambler. More qualitative research is required to understand gendered processes in gambling, as well as further research on interventions that go beyond the individual and address gambling and problem gambling at various levels. When addressing the harmful effects of gambling from a public health perspective, it is imperative to recognize the ethical principles of justice, autonomy, doing no harm and beneficence. / -

Problem gambling currently affects between 5-7% of youth ages 12-18 (Hardooon & Derevensky, 2002); however, rates of problem gambling among youth who are involved with the Juvenile Justice System are more than twice that of school sample rates (Lieberman & Cuadrado, 2002). Furthermore, disordered gambling often co-occurs with substance use and criminal activity (Huang & Boyer, 2007), issues that are compounded in the Juvenile Justice population. The current study assessed gambling behaviors and risk factors of 145 youth involved in juvenile, juvenile drug, and family courts. Results indicated that nearly 13% of these youth are currently problem gamblers, and that males and African-Americans had higher problem gambling rates than female and Caucasian youth. Furthermore, gambling-related crime, substance use, scope of gambling activities, and time in detention facilities were all predictive of problem gambling severity, while suicidal ideation, urban environment, and lottery sales per capita were not. Finally, having a parent with a gambling problem also emerged as a risk factor;however, the risk was greater for males than for females. These results present a distinct need for youth to be screened for gambling problems upon entering and exiting the Juvenile Justice System, and for prevention and intervention services to be offered within juvenile and family court settings. Furthermore, communities need to take an active role in preventing youth gambling problems through increasing public awareness and insuring that appropriate and accurate messages reflecting gambling opportunities and outcomes are presented.

Objetivo: Estudar o comportamento de adolescentes em relação aos jogos de aposta utilizando uma amostra representativa da população brasileira, que permite: a) examinar a prevalência da participação de adolescentes em jogos de aposta num país em desenvolvimento; b) determinar a prevalência de jogo problemático e patológico em adolescentes brasileiros utilizando um instrumento específico para a idade; e c) comparar a associação entre diferentes níveis de envolvimento com jogos de aposta e variáveis sócio-demográficas. Métodos: Usando amostragem probabilística, estratificada e por conglomerados, obteve-se uma amostra representativa da população brasileira com 14 anos ou mais, de ambos os gêneros, em todo o território nacional. Destes, 661tinham entre 14 e 17 anos de idade. Para avaliar jogo problemático e patológico, foram utilizados o Lie/Bet Questionnaire e o DSM-IV-MR-J. Resultados: Dos 661 adolescentes da amostra, 7% relataram participação em jogos de aposta nos últimos meses, 2,8% responderam positivamente no questionário de triagem e 1,6% foram classificados como jogadores problemáticos e patológicos. Na análise multivariada, os fatores associados com jogo problemático e patológico foram sexo masculino, não estar estudando e considerar religião como não importante. Para estes adolescentes, o tempo médio entre começar a fazer apostas regulares e desenvolver o primeiro problema decorrente do jogo foi de menos de 4 meses. Conclusão: Embora a participação de adolescentes brasileiros em jogos de azar tenha sido bastante inferior à usualmente relatada em países desenvolvidos, a prevalência de jogo problemático e patológico nesta pesquisa foi similar à de estudos recentes que utilizaram amostras nacionalmente representativas. A associação de jogo problemático e patológico com sexo masculino, evasão escolar e baixa religiosidade suporta a teoria de que o envolvimento intenso com jogos de aposta faz parte de um grupo de comportamentos desviantes e de alto-risco que ocorrem de modo conjunto na adolescência. A rápida progressão para jogo problemático e patológico fornece mais evidências de que os adolescentes sejam mais vulneráveis aos efeitos dos jogos de azar. / Objective: To study adolescent gambling behavior in a representative sample of the Brazilian population, which allows: a) to investigate the extent to which adolescents participate in gambling activities in a developing country, b) to provide the first estimate of problem and pathological gambling among Brazilian adolescents using an age-specific instrument, and c) to compare different levels of gambling behavior according to demographic and gambling variables. Method: A multistage cluster sampling procedure was used to select 3,007 individuals over 14 years of age, of both sexes, from all over the country. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. Results: Of a total of 661 adolescents, 7% reported gambling participation in the preceding months, 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. At multivariate analysis, factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as a non-important issue. For these adolescents, less than four months elapsed between the age of regular gambling involvement and the age of the first gambling problem. Conclusion: Although the Brazilian adolescent’s participation in gambling activities was much lower than usually reported from developed countries, prevalence rate of adolescent problem and pathological gambling in this survey was quite similar from recent studies which used nationally representative samples. The association between problem and pathological gambling with male sex, school drop-out and low religiosity supports the theory that heavy gambling is part of a constellation of highrisk and deviant behaviors which cluster together in adolescence. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Objetivo: Estudar o comportamento de adolescentes em relação aos jogos de aposta utilizando uma amostra representativa da população brasileira, que permite: a) examinar a prevalência da participação de adolescentes em jogos de aposta num país em desenvolvimento; b) determinar a prevalência de jogo problemático e patológico em adolescentes brasileiros utilizando um instrumento específico para a idade; e c) comparar a associação entre diferentes níveis de envolvimento com jogos de aposta e variáveis sócio-demográficas. Métodos: Usando amostragem probabilística, estratificada e por conglomerados, obteve-se uma amostra representativa da população brasileira com 14 anos ou mais, de ambos os gêneros, em todo o território nacional. Destes, 661tinham entre 14 e 17 anos de idade. Para avaliar jogo problemático e patológico, foram utilizados o Lie/Bet Questionnaire e o DSM-IV-MR-J. Resultados: Dos 661 adolescentes da amostra, 7% relataram participação em jogos de aposta nos últimos meses, 2,8% responderam positivamente no questionário de triagem e 1,6% foram classificados como jogadores problemáticos e patológicos. Na análise multivariada, os fatores associados com jogo problemático e patológico foram sexo masculino, não estar estudando e considerar religião como não importante. Para estes adolescentes, o tempo médio entre começar a fazer apostas regulares e desenvolver o primeiro problema decorrente do jogo foi de menos de 4 meses. Conclusão: Embora a participação de adolescentes brasileiros em jogos de azar tenha sido bastante inferior à usualmente relatada em países desenvolvidos, a prevalência de jogo problemático e patológico nesta pesquisa foi similar à de estudos recentes que utilizaram amostras nacionalmente representativas. A associação de jogo problemático e patológico com sexo masculino, evasão escolar e baixa religiosidade suporta a teoria de que o envolvimento intenso com jogos de aposta faz parte de um grupo de comportamentos desviantes e de alto-risco que ocorrem de modo conjunto na adolescência. A rápida progressão para jogo problemático e patológico fornece mais evidências de que os adolescentes sejam mais vulneráveis aos efeitos dos jogos de azar. / Objective: To study adolescent gambling behavior in a representative sample of the Brazilian population, which allows: a) to investigate the extent to which adolescents participate in gambling activities in a developing country, b) to provide the first estimate of problem and pathological gambling among Brazilian adolescents using an age-specific instrument, and c) to compare different levels of gambling behavior according to demographic and gambling variables. Method: A multistage cluster sampling procedure was used to select 3,007 individuals over 14 years of age, of both sexes, from all over the country. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. Results: Of a total of 661 adolescents, 7% reported gambling participation in the preceding months, 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. At multivariate analysis, factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as a non-important issue. For these adolescents, less than four months elapsed between the age of regular gambling involvement and the age of the first gambling problem. Conclusion: Although the Brazilian adolescent’s participation in gambling activities was much lower than usually reported from developed countries, prevalence rate of adolescent problem and pathological gambling in this survey was quite similar from recent studies which used nationally representative samples. The association between problem and pathological gambling with male sex, school drop-out and low religiosity supports the theory that heavy gambling is part of a constellation of highrisk and deviant behaviors which cluster together in adolescence. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Objetivo: Estudar o comportamento de adolescentes em relação aos jogos de aposta utilizando uma amostra representativa da população brasileira, que permite: a) examinar a prevalência da participação de adolescentes em jogos de aposta num país em desenvolvimento; b) determinar a prevalência de jogo problemático e patológico em adolescentes brasileiros utilizando um instrumento específico para a idade; e c) comparar a associação entre diferentes níveis de envolvimento com jogos de aposta e variáveis sócio-demográficas. Métodos: Usando amostragem probabilística, estratificada e por conglomerados, obteve-se uma amostra representativa da população brasileira com 14 anos ou mais, de ambos os gêneros, em todo o território nacional. Destes, 661tinham entre 14 e 17 anos de idade. Para avaliar jogo problemático e patológico, foram utilizados o Lie/Bet Questionnaire e o DSM-IV-MR-J. Resultados: Dos 661 adolescentes da amostra, 7% relataram participação em jogos de aposta nos últimos meses, 2,8% responderam positivamente no questionário de triagem e 1,6% foram classificados como jogadores problemáticos e patológicos. Na análise multivariada, os fatores associados com jogo problemático e patológico foram sexo masculino, não estar estudando e considerar religião como não importante. Para estes adolescentes, o tempo médio entre começar a fazer apostas regulares e desenvolver o primeiro problema decorrente do jogo foi de menos de 4 meses. Conclusão: Embora a participação de adolescentes brasileiros em jogos de azar tenha sido bastante inferior à usualmente relatada em países desenvolvidos, a prevalência de jogo problemático e patológico nesta pesquisa foi similar à de estudos recentes que utilizaram amostras nacionalmente representativas. A associação de jogo problemático e patológico com sexo masculino, evasão escolar e baixa religiosidade suporta a teoria de que o envolvimento intenso com jogos de aposta faz parte de um grupo de comportamentos desviantes e de alto-risco que ocorrem de modo conjunto na adolescência. A rápida progressão para jogo problemático e patológico fornece mais evidências de que os adolescentes sejam mais vulneráveis aos efeitos dos jogos de azar. / Objective: To study adolescent gambling behavior in a representative sample of the Brazilian population, which allows: a) to investigate the extent to which adolescents participate in gambling activities in a developing country, b) to provide the first estimate of problem and pathological gambling among Brazilian adolescents using an age-specific instrument, and c) to compare different levels of gambling behavior according to demographic and gambling variables. Method: A multistage cluster sampling procedure was used to select 3,007 individuals over 14 years of age, of both sexes, from all over the country. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. Results: Of a total of 661 adolescents, 7% reported gambling participation in the preceding months, 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. At multivariate analysis, factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as a non-important issue. For these adolescents, less than four months elapsed between the age of regular gambling involvement and the age of the first gambling problem. Conclusion: Although the Brazilian adolescent’s participation in gambling activities was much lower than usually reported from developed countries, prevalence rate of adolescent problem and pathological gambling in this survey was quite similar from recent studies which used nationally representative samples. The association between problem and pathological gambling with male sex, school drop-out and low religiosity supports the theory that heavy gambling is part of a constellation of highrisk and deviant behaviors which cluster together in adolescence. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.

Problem gambling is a public health issue that affects gamblers, relatives and society in general. The Swedish National Gambling Helpline, Stödlinjen, operates as a primary help to people with problems related to gambling. The 22,260 calls made to the helpline from 2009 to 2016 were studied with regards to gender, age, online gambling, psychosocial problems, and crime. Comparison between gamblers and relatives revealed gender and age differences. Reports of online gambling increased for both groups as time progressed, while crime declined. The results are discussed, and it is concluded that more research on the connection between gambling and crime is needed, as well as further develop a crime-aspect in the counsellors’ documentation of helpline callers.

Massachusetts passed legislation in the fall of 2012 to allow the construction of three casinos and a slot parlor in the state. The prevalence of problem gambling in the state and in areas where casinos will be constructed is of particular interest. The goal is to evaluate the change in prevalence after construction of the casinos, using a multi-mode address based sample survey. The objective of this thesis is to evaluate and describe ways of using statistical inference to estimates prevalence rates in finite populations. Four methods were considered in an attempt to evaluate the prevalence of problem gambling in the context of the gambling study. These methods were evaluated unconditionally and conditionally, controlling for gender, using mean square error (MSE) as a measure of accuracy. The simple mean, the post-stratified mean, the best linear unbiased predictor (BLUP), and the empirical best linear unbiased predictor (EBLUP) were considered in three examples. Conditional analyses of a population with N=1,000 and a crude problem gambling rate of 1.5, samples of n=200 led to the simple mean and the post-stratified mean to perform better in certain situations, as measured by their low MSE values. When there are less females than expected in a sample, the post-stratified mean produces a lower mean MSE over the 10,000 simulations. When there are more females than expected in a sample, the simple mean produces a lower mean MSE over the 10,000 simulations. Conditional analysis provided more appropriate results than unconditional analysis.