I can't fit one more thing on my plate! Infusing problem gambling prevention into other prevention efforts

integrating problem gambling

in PreventionJulie Hynes, MA, CPS

Four Directions: Tree of Healing ConferenceOctober 2, 2013

Please…Not one more thing!

goals

• Why problem gambling is so important to address

• Give you some time tested prevention tools so you can use them where you work

• Save you from reinventing the wheel• Encourage you to share whatever you come up with as well!

First thing’s first:

www.preventionlane.org/4directions

Creating conditions in families,schools, and communities that

promote the wellbeingof people.

contribute

We do a lot to try to protect young people…

PROBLEM BEHAVIORS

Effects of Problem Gambling on Children

“A” Unique Set of Risks

Youth gambling is still under the radar.

Anotherrisk factor

The PREFRONTAL CORTEX is the LAST PART to develop.

years old!

The brain is still

developinguntil

•Amygdala active •Fight or flight, emotion•Decision‐making altered

•More vulnerable to risk‐taking & impulsive behaviors

Source: Ramoski, S., Nystrom, R. (2007).

“The adolescent brain is especially sensitive to the

effects of dopamine.

5.6% college age (18‐24)

2½ % all adults (18+)

4% teens (13‐17)

This is the first generation of widely available electronic gambling.

We really don’t know the effects yet.

Why? Is it the generation? Technology? Or what?

AWARENESS (low)

2012 Oregon Student Wellness Survey, Lane County (“ESD”) and Oregon; available at http://oregon.pridesurveys.com/esds.php?year=2011

Targeting Parental Attitudes

Most parents believe:• Youth gambling is harmless • Youth who gamble are unlikely to have problems in school

• Youth gambling is not associated with alcohol or drug use

…and those beliefs are part of the problem

ATTITUDESOregon parent/youth focus groups revealed:

All parents in their focus groups said their kids didn’t gamble

All of their kids, who were in their own focus groups, said they did gamble

Neither sees gambling as risky

2012 OregonStudent Wellness Survey (SWS)

2012 Gambling, Substance Use and Mental Health among Oregon Youth

0%

10%

20%

30%

40%

50%

Gambling Alcohol BingeAlcohol

Marijuana CigarettesDepression Psychdistress

Percen

tage

6th 8th

11th

Source: http://oregon.pridesurveys.com/esds.php?year=2011n=55,611 students (18,885 6th grade; 21,368 8th grade; 15,358 11th grade)

Used alcohol in the past month

3.1%

14.6%

29.5%

14.9%

30.9%

46.9%

Grade 6 Grade 8 Grade 11

Did not gamble Gambled

Binge drank in the past month

0.5%5.6%

16.4%

4.3%

12.7%

28.7%



Available at: www.preventionlane.org/sws.htm

Smoked cigarettes in the past month

1.1%6.2%

12.5%

5.1%

10.8%

18.7%




Used marijuana in the past month

0.7%

8.3%

19.3%

4.3%

15.8%

28.4%




Skipped school one or more days in the past month

5.7%

12.8%

22.5%

15.4%

23.0%

35.4%




7.2%5.0%

11.3%9.0%

Grade 8 Grade 11



Attempted suicide in the past year

Attempted suicide in the past year

10.1%8.0%

21.0%18.6%

Grade 8 Grade 11

Did not bet/gamble more than wanted toBet/gambled more than wanted to

Delinquency (physical fight in last month)

41.80%

22.40%

Physical fight

Gambled Did not gamble

CONCLUSION?

Teens who gamble are smoked up, toked up,

drunk emo delinquents.

CONCLUSION?

Teens who gamble are smoked up, toked up,

drunk emo delinquents.

What do the data tell us about risk & youth

gambling? How would you interpret the data?

delinquency

sexualbehavior

depression

substanceuse

gambling

ProblemBehaviors

Conclusion: Problem Gamblingis ONE COMPONENT of

Problem Behaviors

Protective Factors & Gambling

60.60%

29%

65.90%

21.80%

Strong Positive Youth development Depression


43.80%

32.90%

53.70%

23.20%

Likes school absenteeism


Protective Factors & Gambling

TAKING THAT…And Using PREVENTION science

contribute

Resi

lien

cy T

heo

ry

ADVERSE CHILDHOOD EXPERIENCES (ACE)

40 DEVELOPMENTAL ASSETS

SOCIAL DEVELOPMENT STRATEGY

PROMOTIVE FACTORS

Risk & Protective Factor Theory

• Similar to medical model

• Problem behaviors share common risk factors

• Risk factors increase the chance of behavior problems

• Protective factors can help buffer the effects of risk factors

The Risk Factor/Protective Factor Theory

Risk-Focused Prevention• Prevent problem behavior from happening:

– Identify factors that increase risk of problem and then find ways to reduce those risks

– Enhance protective/resiliency factors

• 30+ years of research: Hawkins, Catalano & other researchers

• Four Domains: – Community ‐‐ Family– School ‐‐ Individual/Peer

Risk & Protective Factors

• Exposure to a greater number of risk factors a young person’s risk exponentially

• Reducing or eliminating even a few risk factors may significantly risk for youth

• Protective factors buffer exposure to risk

• Protective factors build on strengths of individual, family, community

Risk Factors for Adolescent Problem Behavior

Recognized Problem Behaviors

• Substance abuse

• Violence

• Delinquency

• Teenage pregnancy

• School dropout

Problem gambling??– Apparently similar risk factors

– Very high co-occurrence between problem gambling & other problem behaviors, especially alcohol/substance abuse

Potential Risk Factors for Problem Gambling

• Community:– Availability– Community Laws & Norms

• Family:– Family History– Family Conflict (competition)– Parental Attitudes/Involvement

Source: Marotta & Hynes, 2003

Source: Marotta & Hynes, 2003

Potential Risk Factors for Problem Gambling

• School:– Anti‐Social behavior

• Individual/Peer:– Peer Involvement– Favorable Attitudes– Early Initiation – Constitutional

Being male, older teen Single‐parent household Gambling on

cards/sports Lower household income Competitive Having lost more than

$50 in a single monthStarted gambling before 8th grade

Parents who are alcohol/substance abusers

Parents who gamble*

Source: Volberg, et al (2008; bid).

Key risk factors for YOUTH:

* Youth are TWICE as likely to be at-risk

gamblers & FOUR TIMES as likely to be PROBLEM

GAMBLERS.

Protective Factors: Characteristics

• Individual Characteristics:– Gender– Resilient Temperament– Positive Social Orientation– Intelligence

• Protective Processes:– Opportunities for involvement– Social and cognitive skills– Recognition

Dickson, Derevensky & Gupta, 2002

“The earlier people begin gambling, the more likely

they are to experience problems from gambling.”

- National Academy of Sciences

By creating nurturing environments using EVIDENCE-BASED PREVENTION PRACTICES

NOW:PREVENTION in action

Common Goals

“Denormalization”

Prevention

Protection

Harm Reduction

using ourevidence base

Follow-up link: best practiceshttp://preventionlane.org/best-practices.htm

Find a focus (or two)• Public awareness• Policy• School‐based curriculum

• Parent education

The right support to the right people

Ideally, we would have varying levels of support to meet the needs of diverse youth and their families.

Size of population affected

More intensive for at‐risk youth and families~15%

Most intensive interventions for the youth and families at highest risk~10%

Universal supports for all youthand families~75%

Information Dissemination

Prevention Education

Alternative Activities

Community-Based Processes

Problem Identification/ Referral

Environmental/Policy Approaches

A Common Approach: Uses the Center for Substance Abuse Prevention Strategies for Effective Prevention

Prevention Efforts: Shared Environments

• Information Dissemination: moving readiness… first step is to acknowledge there’s an issue!

• Community‐based prevention coalitions– Communities that Care

• Norms, Policies & Law– Social Host Ordinance– Gambling

Prevention Efforts: Individualized Environments

• Identification & referral• Problem gambling ‐ LIE‐BET (see www.preventionlane.org/lie‐bet)

• School‐based prevention• Reconnecting Youth• RESPONSE (H.S. suicide prevention)• Problem gambling integration with ATOD curricula

• Family support• Evidence‐based parenting classes

SPECIFIC examples







Peer to Peer Campaign

Video Contest & Art Search• Cheap• Great for integration in schools where health curriculum not a possibility

• Ask media, A/V, drama teachers about participating• See http://preventionlane.org/videos.htm and http://preventionlane.org/gambling/art‐search.htm for more information

Social Media• Websites, Blogs, Facebook, YouTube, Twitter, etc.

• Fairly inexpensive & easy to update!

SPECIFIC examples







Department of Education

• Exhibiting and presenting at school teacher trainings

• ODE health education standards now includes problem gambling at 6‐8th grade level

Above: see http://preventionlane.org/gambling/about-us.htmfor complete chart & information

CSAP: Policy

Partnering with schools• Casino night alternatives• Parenting programs (e.g., Strengthening Families)• Selective prevention programs (e.g., Reconnecting Youth)

• Adding language about gambling into any drug or alcohol curriculum

• In‐class presentations that can fold in with problem gambling

• Sample policies (see student handbooks)

CSAP: Info dissemination, policy, community process, education, ID & referral (possibly alternative activities)

•Refusal skills•Media advocacy•Decision making

This is an ADD-IN to other material; addictions prevention curricula

• 1 in 175• 1 in 175,000

• 1 in 175 million• 1 in 175 billion

1 in 175 Million(174,233,510)

Odds of getting struck by lightning: 1 in 280,000

Name at least 2 consequences that

someone may experience due to his/her gambling

problem

• Debt• Crime• Depression/Suicide• Relationship problems• Employment problems• Alcohol and/or drug problems

Use Your Area’s Existing Best Practice Curricula…add in

language!• Project Northland• Life Skills• Project Alert• Strengthening Families 10‐14• Etc… again, add in the language or tools here.

SPECIFIC examples







Casino night alternatives, art projects, etc.

SPECIFIC examples







Coalitions: Giving People A Voice

• Youth coalitions• Integrating in your prevention coalition

• Specific problem gambling coalitions

• Social media can be part of that!

SPECIFIC examples







Screening & Assessment Tools

• Lie/Bet• South Oaks Gambling Screen (SOGS)• DSM‐V criteria• National Opinion Diagnostic Summary (NODS)

• GA/Gam‐Anon 20 Questions

The above tools are available online at http://npgaw.org/tools/screeningtools.asp

Screening Techniques

• Add to SBIRT (Screening, Brief Intervention, & Referral to Treatment) ‐SAMHSA

• Community health centers• Partner with AOD treatment providers

SPECIFIC examples







Reward and RemindersLottery Scratch Tickets

Thanks to Shawn Martinez of Josephine County, Oregon

Evidence‐Based Strategy effectively used for Alcohol and Tobacco

retailers, many of whom are lottery retailers as well.

CONDUCTING REWARD AND REMINDER VISITS

•Student/ Parent training•Parent and Student consent form signed and returned

•Practice

Clerk Sales

• Students only have one dollar in cash with them and ID• Two students enter store with adult advisor following

behind• One student picks up an item that is $1 of less• At counter student ask for scratch ticket. At no time does

the student pick up the ticket• If the clerk gets the ticket, totals the sale and asks for money

student say they don’t have enough money, pays for item and the second student reminds them that lottery tickets cannot be purchased by anyone under the age of 18

• If the clerk asks for ID, show it• If the clerk does not sell, give them their reward and thank

the clerk for not selling

Clerk Sales

• Never lie• If they are in a tough situation leave the store

• If student is uncomfortable for any reason –leave

• The students fill out the data form with information from the visit

JUST A REMINDER!One in every 25 Oregon teens (13‐17 year olds) is a problem or at risk

gambler– that’s more than 10,000 Oregon teens.

REMEMBERORS 461.600 Sales to minors. (1) Tickets or shares in lottery games,

including tickets or shares sold from vending machines or other devices, may not be sold to a person under 18 years of age.

ORS 461.300 Selection of retailers; rules; contracts (4) The director may terminate a contract with a lottery game retailer based on the grounds for termination included in the contract or commission rules governing the contract. The grounds for termination must include, but are not limited to, the knowing sale of lottery tickets or shares to any person under the age of 18 years or knowingly permitting a person under the age of 21 years to operate a video lottery game terminal.

Uh-oh! … Reminder Slip

Yay!... The Reward

• GIFT CARD (coffee, pizza, movie ticket)• T‐shirt• Coffee Mug• Keychain• Pencil / Pen

Vending Machine

• Students only have one dollar in cash with them and ID

• Two students enter store with adult advisor following behind

• One student locates the vending machine• One of the students put $1 in machine• Students may not lie if asked age or date of birth• Second student is just observing employees or others in store

• If the machine sells a ticket to student it is handed to the adult

Vending Machine

• Never lie• If they are in a tough situation leave the store

• If student is uncomfortable for any reason – leave

• The students fill out the data form with information from the visit

FOLLOW UP AFTER VISITS

• Letter to store owner manager– Congratulation s– Regretfully – Information to share with employees

• Any scratch tickets purchased are sent to State Lottery Commission

Observations

• Youth felt some of the vending machine were in hidden areas or not in sight of any employees to monitor.

• Youth felt if someone wanted a ticket they could push the button that says they are over 18.

• Some of the machines were by customer service and when they put money into the machine or was looking at the machine with employees or other adults close by no one said anything to the youth.

Instant Ticket Vending Machine (ITVM)

Lottery ticket machine (RIGHT) is out of sight of cashier, whereas movie machine (LEFT) is in sight

Placement of Lottery machine next to movie machine draws kids’ interest







WHEW…OK. BUT WHAT ARE ALL THE

right path

System Evaluation Results

Prevention and outreach are working:

• Evaluation report in Oregon shows many successes; see http://problemgamblingprevention.org/reports/08‐09‐AD80‐Annual‐Reports‐Summary.pdf for more complete report

• Oregon is one of the few states that appears to have averted a significant increase in problem gambling prevalence while expanding legalized gambling (National Center For the Study of Gambling, 2006)

1. Moore & Marotta, in press2. National Center For the Study of Gambling, 2006.

Evidence-based prevention programs save money

• On average, for every dollar invested in these evidence‐based prevention programs nationwide…– $6 was saved with Project Alert– $8 was saved with Adolescent Transitions Program

– $11 was saved with Strengthening Families 10‐14

– $35 was saved with Good Behavior Game

Youthful subject

Perception of harmlessness

Stigma/shame

Industry

KEY challenges

Gratuitous pic of my kid

Successes… & Challenges

• Approaching schools/coalitions with internal partners

• Sharing how this BENEFITS them, not adds work

• Using “Why should you care?” message

• Using local data• Knowing the language (e.g.,

education standards)• Asking questions

• Gambling still not on radar• Lack of resources & time• Strict curriculum demands

Where can I find these materials?

www.problemgamblingprevention.org

and www.preventionlane.org

RECAP

MORE RESOURCES

Excellent WA prevention resource: evergreencpg.org

Info & general prevention resource:

preventionlane.org/gambling

Curriculum, outreach resource:problemgamblingprevention.org

Data & Info

• Updated annually• Contains facts and figures,

factsheets, overviews, templates, etc. for increasing awareness of problem gambling

• Can be downloaded at http://problemgamblingprevention.org/

The Take-Home

• Integration is needed in today’s world• Don’t overcomplicate it• Use tools available to you with the time you have

• Ask for help! Problem gambling experts love to help.

541.682.3928

For more info & resources,visit www.preventionlane.org

[email protected] julhynes1