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Maria Anna Donati ,
Francesca Chiesi , & Caterina Primi
U N I V E R S I T Y O F F L O R E N C E
I T A L Y
Gambling in youths:
A new scale to measure
pathological gambling behavior
Gambling in adolescence
• A large number of adolescents are involved in
gambling activities (e.g., Scholes-Balog et al., 2014).
• Between 60 and 99% of young people aged 12–20
years gambled over the past year (Splevins et al., 2010).
• Despite boys gambled more than girls, female
adolescent gamblers are increasing (Bastiani et al., 2010).
Youth gambling problems
• A high proportion of young people gamble
excessively, developing a wide array of
psychological, social, and economic problems (e.g.,
see Ariyabuddhiphongs, 2013).
• Problem gambling among adolescents is four or five times
higher than among adults (e.g., Olason & Gretarsson, 2009).
• Gambling as a central public health issue of
prevention research and practice (see Blinn-Pike et al.,
2010).
The measurement
• Much attention has been paid to the issue of
measurement (for reviews, see Derevensky & Gupta, 2004; 2006;
Stinchfield, 2010).
• The 3 most commonly used instruments are:
• South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) (Winters et al., 1993);
• DSM-IV-Juvenile (DSM-IV-J) and its revision, DSM-IV-
Multiple Response-Juvenile (DSM- IV-MR-J) (Fisher, 1992; 2000);
• Massachusetts Adolescent Gambling Screen (MAGS)
(Shaffer et al., 1994).
Limitations in the measurement
• Adaptation from adult instruments, with minor changes
in the wording of some items (Chiesi et al., 2013);
• Dichotomous response format (or it becomes
dichotomous in the scoring procedure), while a Likert-
type format offers more advantages psychometrically
(Muňiz et al., 2005);
• No evidence for equivalence among male/female
(Derevensky & Gupta, 2004) and younger/older
respondents;
• No screens based on the new DSM-5.
Gambling Disorder in DSM-5
From DSM-IV to DSM-5
From Pathological Gambling to Disordered Gambling;
From Impulse-Control Disorders not elsewhere classified to
Substance-Related and Addictive Disorders;
From ten to nine criteria: One criterion (to commit illegal
acts) has been eliminated;
From five to four criteria for diagnosis: lower threshold;
Different forms of the disorder are specified (mild, moderate,
severe);
Specified time period: symptoms must be present during a
12 month time period.
Aim
• To develop a new brief scale to assess
pathological gambling among adolescents
(Gambling Behavior Scale for Adolescents, GBSA)
referring to the DSM-5:
o Adapting the criteria to adolescent lives
o Using a multiple-response format
o Applying Item Response Theory (IRT) • Testing the equivalence for male/female and younger/older respondents
o Providing validity evidence.
Item Response Theory (IRT)
IRT aims to show the probabilistic relationship
between pattern responses, latent characteristics of
respondents, and item properties.
Advantages of IRT: Fit of the measurement model
Parameter estimates of items that define their ability to
discriminate and to measure different levels of the latent trait
(θ)
Precision of the test at different levels of θ (Reliability)
Differential Item Functioning (DIF) across different groups.
Method
Participants
o 1723 adolescents attending middle and high school
(56% males, mean age=15.64 years, SD=1.79, 11-23
years):
• 265 (15%) middle school (II year);
• 1458 (85%) high school (23% I year; 30% II year; 19% III
year; 28% IV year).
Method
Measures • Gambling Behavior Scale for Adolescents (GBSA): 33
items - referred to the last 12 months - with a 5 point scale (1=never, 2 = rarely,
3 = sometimes, 4 = often, 5 = very often).
o This version was
obtained starting from
a preliminary set of 45
items tested in pilot
studies at both
qualitative and
quantitative levels.
DSM-5
Criteria
Step 0:
45 items
Step 1:
33 items
Tolerance 5 3
Withdrawal 5 4
Loss of Control 5 4
Preoccupation 5 3
Escape 5 3
Chasing 5 4
Lying 5 4
Risk/lose relationships/opportunities
5 5
Bailout 5 3
Method
Measures
• Questionnaire on gambling behavior in the last 12
months (activities and relative frequency);
• South Oaks Gambling Screen – Revised for
Adolescents (SOGS-RA) (Winters et al., 1993; Italian version:
Colasante et al., 2013)
• Illusion of Control (GRCS-IC) (Raylu & Oei, 2004; Italian
version: Donati et al., 2014)
• Gambling Attitude Scale (GAS) (Delfabbro & Thrupp,
2003; Italian version: Primi et al., 2013)
Results – Preliminary Analysis
o Analyses were conducted with adolescents who
gambled
• N=1187 (69%) (59% males, mean age=15.66 years,
SD=1.71).
o Since item response distributions were strongly skewed,
we converted the 5-point scale into a 3-point scale
(never = 1, rarely/sometimes = 2, often/very often = 3).
o The 33 item-version resulted to be unidimensional.
Results – Item selection and calibration
• The fit of the unidimensional
two parameter model was
tested: • Seven items were eliminated since they
did not fit to the model.
• We performed the IRT
calibration with the remaining
26 items: • For each criterion we selected the
best functioning items relying on IRT
discrimination parameters.
DSM-5
Criteria
Step 1:
33
items
Tolerance 3
Withdrawal 4
Loss of
Control 4
Preoccupation 3
Escape 3
Chasing 4
Lying 4
Risk/lose relationships/opportun
ities
5
Bailout 3
DSM-5
Criteria
Step 1:
33
items
Step 2:
26
items
Tolerance 3 3
Withdrawal 4 4
Loss of
Control 4 4
Preoccupation 3 1
Escape 3 2
Chasing 4 1
Lying 4 4
Risk/lose relationships/opportun
ities
5 5
Bailout 3 2
DSM-5
Criteria
Step 1:
33
items
Step 2:
26
items
Step 3:
9
items
Tolerance 3 3 1
Withdrawal 4 4 1
Loss of
Control 4 4 1
Preoccupation 3 1 1
Escape 3 2 1
Chasing 4 1 1
Lying 4 4 1
Risk/lose relationships/opportun
ities
5 5 1
Bailout 3 2 1
Item DSM-5 a b1 b2
1 Tolerance .67 3.50 (0.34) 1.66 (0.10) 2.83 (0.22)
2 Withdrawal .69 2.98 (0.29) 1.55 (0.09) 2.35 (0.18)
3 Loss of Control .63 3.02 (0.38) 1.72 (0.11) 2.52 (0.18)
4 Preoccupation .52 1.89 (0.19) 1.35 (0.10) 2.21 (0.17)
5 Escape .68 2.29 (0.25) 1.62 (0.11) 3.02 (0.24)
6 Chasing .53 1.66 (0.16) 0.82 (0.07) 2.80 (0.21)
7 Lying .58 2.53 (0.30) 1.56 (0.10) 2.56 (0.19)
8 Risk/lose relationships/
opportunities
.68 3.19 (0.38) 1.65 (0.10) 2.65 (0.17)
9 Bailout .70 1.84 (0.19) 1.52 (0.11) 2.87 (0.24)
Factor loadings and item parameters
Test Information Function (TIF)
o The TIF shows the precision of the test at
different levels of the latent trait
M(trait)
Differential Item Functioning (DIF) across gender and age
An item is considered to exhibit DIF if respondents
of two different groups who have equal levels of the
trait do not have the same probability of responding
affirmatively to that item.
Comparing male and female gamblers and younger
and older gamblers (based on the median age of
around 16 years old), no items exhibited DIF with
respect to:
Discrimination parameters (a)
Severity parameters (b)
Validity
GBSA-total
score
Gambling Frequency .44***
Gambling Versatility .33***
Illusion of Control .48***
Perception of gambling profitability .30***
Problem gambling .55***
*** p<.001
Discussion
• Referring to the DSM-5 definition of GD and
using the IRT approach, this scale seems to be a
reliable and valid brief tool to accurately
measure medium and high levels of gambling
problems among adolescents.
It could be especially useful to identify severe levels
of gambling problems in adolescents, regardless of
their gender and age.
Conclusion
• The GBSA is likely to be a useful screening
and diagnostic instrument for gambling
research and practice with adolescents.
• Future research is needed to:
• Test its psychometric properties with
adolescents who are in treatment for their
gambling problems (clinical samples).
• Develop new IRT-based cut-offs.
• Conduct cross-cultural studies.
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