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Biomedical subjects

Howard J Shaffer

Publications and source records attributed to Howard J Shaffer.

At least 19 recordsLinked to original sources
PubMed2007

Missouri casino self-excluders: distributions across time and space.

According to public health research, exposure to casinos is a risk factor for disordered gambling. Consequently, casino self-exclusion programs, which provide gamblers with the opportunity to voluntarily seek limits on their access to gambling venues, can serve as a barometer of the concentration of disordered gambling in an area. This study reports on the distribution, both temporally and geographically, of 6,599 people who applied to exclude themselves from Missouri casinos between November, 1996 and February, 2004. Analyses used Microsoft MapPoint to plot the location of casinos and self-excluders (SEs) across Missouri and its constituent counties. These regional exposure analyses showed that the Western region around Kansas City is an epicenter of disordered gambling as, to a lesser extent, is the Eastern region around St. Louis. The annual number of SE enrollments increased during the first few years of the Missouri self-exclusion program and then leveled off during the later years. These findings have important implications for public health and the development of public health interventions for disordered gamblers.

Adult↗
PubMed2006

The proxy effect: gender and gambling problem trajectories of iowa gambling treatment program participants.

Recent research has found that men and women who end up in gambling treatment tend to follow different trajectories to that endpoint: women generally begin gambling later in life, but progress to problems and seek treatment more quickly. With women's prevalence rates of gambling and disordered gambling increasing, it has become important to identify the causes and consequences of these trajectory differences. The current study used a sample of 2,256 gamblers enrolled in the Iowa Gambling Treatment Program to examine the relationship of gender and other demographic, economic and health-related (i.e., psychosocial) factors to empirically-identified gambling problem trajectories. The results indicated that gender made a statistically significant contribution to the prediction of trajectory, but increased predictive accuracy by only 1-2% beyond a model with psychosocial predictors. Gender's contribution was limited to its relationship to age of initiation; men and women's problem progression did not differ meaningfully once age of gambling initiation was taken into account. Gender is a unique contributor to the development of gambling problems among treatment seekers, but it is only one small part of the myriad psychosocial characteristics that influence gambling problem development.

Aged↗
PubMed2006

Men & women playing games: gender and the gambling preferences of Iowa gambling treatment program participants.

Historically, gambling has been a predominantly male pastime; however, as legalized gambling has expanded, female participation has increased. Nevertheless, some research suggests that a divide remains between the play patterns of men and women. For example, research suggests that men gravitate towards casino table games and track betting and women are attracted to games such as bingo and casino slots. Researchers have hypothesized that play pattern disparities exist because of inherent differences between the natures of men and women. Using data from 2256 (1309 male) problem gambling treatment participants, this research examines the influence of gender on play patterns. We tested the ability of gender and a series of demographic, economic, and health-related factors to discriminate among three groups of gamblers with different game preferences: casino preferred, slots preferred, and non-institutional preferred. The results of multiple discriminant function analyses indicated that gender provided a minimal contribution to discrimination beyond that of specific demographic, economic, and health-related factors. This finding suggests that for understanding gambling patterns, gender is less informative than descriptive gambler profiles.

Adult↗
PubMed2006

Trends in gambling studies research: quantifying, categorizing, and describing citations.

As opportunities to gamble have increased during the 20th century, so has gambling research. This study used new strategies, methods, and technology to examine citation trends and the growth of knowledge in the field of gambling studies. The sample included 2,246 citations that were published between 1903 and 2003. By using multiple keywords to classify each citation into distinct topic areas, this study yielded a more comprehensive analysis than was previously available. The results reveal that gambling-related research has grown at an exponential rate. The most prevalent topics explored within gambling studies citations have been pathology, risk-taking, decision-making and addiction. Between 1999 and 2003, studies addressing epidemiology, drug abuse, comorbidity and neuroscience have become increasingly prevalent. Based on these trends and their implications, this paper provides several recommendations for both future areas of inquiry within the field of gambling studies and better classification techniques for citations within all fields of psychology.

Abstracting and Indexing↗
PubMed2005

The epidemiology of college alcohol and gambling policies.

BACKGROUND: This article reports the first national assessment of patterns of drinking and gambling-related rulemaking on college campuses (e.g., punitive versus recovery oriented). Analyses relating school policies to known school rates of drinking or gambling identified potentially influential policies. These results can inform and encourage the development of guidelines, or "best practices," upon which schools can base future policy. METHODS: The college policy information was collected from handbooks, Web sites and supplemental materials of 119 scientifically selected colleges included in the fourth (2001) Harvard School of Public Health College Alcohol Study (CAS). A coding instrument of 40 items measured the scope and focus of school alcohol and gambling policies. This instrument included items to measure the presence of specific policies and establish whether the policies were punitive or rehabilitative. A total of 11 coders followed a process of information extraction, coding and arbitration used successfully in other published studies to codify policy information. RESULTS: Although all schools had a student alcohol use policy, only 26 schools (22%) had a gambling policy. Punitive and restrictive alcohol policies were most prevalent; recovery-oriented policies were present at fewer than 30% of schools. Certain alcohol and gambling policies had significant relationships with student binge drinking rates. CONCLUSIONS: The relative lack of college recovery-oriented policies suggests that schools might be overlooking the value of rehabilitative measures in reducing addictive behaviors among students. Since there are few college gambling-related policies, schools might be missing an opportunity to inform students about the dangers of excessive gambling.

Journal Article↗
PubMed2005

Treating problem gamblers: working towards empirically supported treatment.

There is an urgent need for mental health professionals to develop effective treatments for pathological gambling. A scientific meeting was held in Quebec City in June 2002 where 13 specialists in the treatment of gamblers pursued the objectives of making the "State of the art" statement concerning the procedures and the methodology to be used in future treatment outcome studies. This paper introduces this special issue of the Journal of Gambling Studies and identifies some of the key issues that confront clinicians and researchers interested in evidence based treatment for gambling related disorders.

Congresses as Topic↗
PubMed2005

The Iowa Gambling Treatment Program: treatment outcomes for a follow-up sample.

The Iowa Gambling Treatment Program (IGTP) amassed participant data for gamblers and concerned others of gamblers over 4 years (1997-2001). Data collection opportunities included: (1) crisis contacts, (2) placement screening, (3) admission, (4) treatment services, (5) discharge, and (6) follow-up. Among followed gamblers, 74% of treatment completers, 49% of substantial treatment completers, and 36% of dropouts and referrals were abstaining from gambling at 6-month follow-up. The reduction in dollars lost to gambling was similar; 85% of treatment completers, 88% of substantial treatment completers, and 65% of others reduced their dollars lost per week. Although more extensive follow-up efforts are needed to properly evaluate the effectiveness of the IGTP, these results suggest that the IGTP shows promise.

Adult↗
PubMed2004

Gambling participation and social support among older adults: a longitudinal community study.

The purpose of this preliminary study was to examine associations between leaving home to engage in bingo or gambling activity and indices of physical and mental health and social support among a representative community cohort of 1016 elderly people. Cross-sectional and longitudinal data gathered from a prospective epidemiological study in a rural, low socio-economic status, area of Pennsylvania was employed. The cohort had a mean age of 78.8 (SD = 5.1) (range 71-97) and participated in three consecutive biennial "waves" of data collection. Nearly half (47.7) of the cohort reported gambling. To predict gambling, the independent variables included age, sex, education, employment, social support, depressive symptoms, self-rated health, alcohol use, cigarette use, and cognitive functioning. In cross-sectional, univariate analyses, gambling was associated with younger age, sex (male), fewer years of education, greater social support, lower depression scores, better self-rated health, alcohol use in the past year, and higher cognitive functioning. In a cross-sectional multiple regression model, younger age, greater social support, and alcohol use in the past year remain strongly and independently associated with gambling activity. Longitudinally, age, sex, social support, alcohol use, and gambling are predictive of future gambling activity. The results revealed that gambling may offer a forum of social support to older adults who are often isolated as they age.

Age Factors↗
PubMed2004

A science-based framework for responsible gambling: the Reno model.

As social observers increasingly identify gambling-related problems as a public health issue, key stakeholders need to join together to reduce both the incidence and prevalence of gambling-related harm in the community. This position paper describes a strategic framework that sets out principles to guide industry operators, health service and other welfare providers, interested community groups, consumers and governments and their related agencies in the adoption and implementation of responsible gambling and harm minimization initiatives.

Australia↗
PubMed2004

Laying the foundation for quantifying regional exposure to social phenomena: considering the case of legalized gambling as a public health toxin.

Exposure and adaptation models provide competing perspectives of the environmental influence on the development of addictive disorders. Exposure theory suggests that the presence of environmental toxins (e.g., casinos) increases the likelihood of related disease (e.g., gambling-related disorders). Adaptation theory proposes that new environmental toxins initially increase adverse reactions; subsequently, symptoms diminish as individuals adapt to such toxins and acquire resistance. The authors describe a new public health regional exposure model (REM) that provides a tool to gather empirical evidence in support of either model. This article demonstrates how the strategic REM, modified to examine gambling exposure, uses standardized indices of exposure to social phenomena at the regional level to quantify social constructs.

Adaptation, Psychological↗
PubMed2004

The road less travelled: moving from distribution to determinants in the study of gambling epidemiology.

This article reviews the current status of gambling epidemiology studies and suggests that it is time to move from general population-prevalence research toward the investigation of risk and protective factors that influence the onset of gambling disorders. The study of incidence among vulnerable and resilient populations is a road yet to be taken. In this review, we briefly introduce the history of the field and thoroughly review the epidemiologic research on disordered gambling before providing a critical assessment of the current diagnostic tools. Overall, the extant research shows that disordered gambling is a relatively stable phenomenon throughout the world. Given that certain segments of the population (for example, adolescents and substance users) have elevated prevalence rates, we suggest focusing future prevalence studies on groups with apparently increased vulnerability. Moreover, we suggest that, for the field of gambling studies to progress, researchers need to take the road less travelled and examine more carefully the onset and determinants of disordered gambling. That said, given the problems with the current diagnostic screens, investigators need to refine their theoretical concepts and the epidemiologic tools used to examine them before the field can travel down this new road.

Adolescent↗
PubMed2002

Temporal progression of cocaine dependence symptoms in the US National Comorbidity Survey.

OBJECTIVE: Cocaine dependence first appeared as a diagnostic category in 1987 with the publication of DSM-III-R. While the temporal sequencing of alcohol symptoms has a long history, little such attention has been focused on cocaine dependence. This paper examines the retrospective recall of DSM-III-R cocaine dependence symptom progression among a large sample of cocaine users and the relationship of these symptoms to psychiatric comorbidity. METHODS: Using data from the US National Comorbidity Survey, DSM-III-R criterion 'A' cocaine dependence symptoms were sequenced temporally based on age of symptom onset. Each of these numerical symptom strings was examined to determine its prevalence and association to comorbid psychiatric disorders. RESULTS: Cocaine users represented 16%, of the sample. Although hundreds of symptom sequence permutations are possible, only a few are highly prevalent. Subjects whose early onset symptoms are neuroadaptive (e.g. tolerance and withdrawal) are more likely to develop cocaine dependence than subjects whose early symptoms are characterized by psychosocial consequences. Furthermore, certain temporal patterns were found to increase or decrease the presence or absence of cocaine dependence and psychiatric comorbidity. Finally, psychiatric comorbidity preceded rather than followed cocaine use onset disproportionately. CONCLUSIONS: Like alcohol users, cocaine users follow a limited array of symptom sequence pathways from first use to dependence. By better understanding and examining the temporal progression of drug use symptoms, clinicians might improve screening and assessment activities and determine more effectively the extent of risks associated with continued premorbid drug use and enhance treatment-matching. We encourage clinicians to develop evaluation instruments that specifically ask patients to sequence their cocaine use-related symptoms temporally.

Adolescent↗
PubMed2002

The natural history of gambling and drinking problems among casino employees.

From an eligible population of 9,943 casino employees, 6,067 volunteered to participate in this study. Of this sample, 1,176 provided data at 3 observation points approximately 12 months apart. Using the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987) and the CAGE (J. A. Ewing, 1984) questionnaire, the authors prospectively examined the prevalence and patterns of alcohol and gambling problems among those employees. Among the casino employees with gambling and drinking problems, a segment displayed the capacity to diminish those problems even when the difficulties had reached disordered levels. The authors also examined the comorbidity of gambling and drinking as well as the relationships among changes in SOGS scores and CAGE scores and changes in demographic and biological variables. The women were more likely to decrease their problem-drinking scores, but not their gambling scores, when compared with the men. In addition, 2 key variables (i.e., disabling depression and dissatisfaction with one's personal life) emerged as predictors of transitions to healthier levels of disordered gambling. The authors cautiously suggest, in light of the results taken together, that more fluctuation is associated with gambling and drinking problems than previously thought and that the conventional wisdom about disordered gambling as "always progressive" needs reconsideration.

Adult↗
PubMed2002

Gambling disorders among homeless persons with substance use disorders seeking treatment at a community center.

OBJECTIVES: Epidemiological research suggests that homelessness is a risk factor for elevated levels of psychiatric comorbidity and other health risks. This study examined the prevalence of disordered gambling and its association with treatment of psychiatric and substance use disorders among a cohort of homeless people seeking treatment at a community services program. METHODS: Between 1998 and 2000, intake workers evaluated the level of gambling disorder among 171 consecutive homeless persons with substance use disorders who sought treatment at the Moving Ahead Program in Boston. Program staff administered the DSM-IV subscale of the Massachusetts Gambling Screen at intake. RESULTS: The prevalence rates of level 2 and level 3 gambling disorders were 12.8 percent and 5.5 percent, respectively. These rates are higher than that of the general adult population but comparable to those of other patients with substance use disorders and psychiatric diagnoses. Program participants with level 3 gambling disorders had been homeless more often and at a younger age and had had less substance abuse treatment and more psychiatric treatment than participants with level 1 or level 2 gambling disorders. Participants with level 2 gambling disorders had been homeless more often and for a longer duration than participants without gambling disorders. CONCLUSIONS: These findings should encourage clinicians working with homeless people to screen for gambling-related problems and disorders.

Adult↗
PubMed2001

Gambling and related mental disorders: a public health analysis.

This article reviews the prevalence of gambling and related mental disorders from a public health perspective. It traces the expansion of gambling in North America and the psychological, economic, and social consequences for the public's health, and then considers both the costs and benefits of gambling and the history of gambling prevalence research. A public health approach is applied to understanding the epidemiology of gambling-related problems. International prevalence rates are provided and the prevalence of mental disorders that often are comorbid with gambling problems is reviewed. Analysis includes an examination of groups vulnerable to gambling-related disorders and the methodological and conceptual matters that might influence epidemiological research and prevalence rates related to gambling. The major public health problems associated with gambling are considered and recommendations made for public health policy, practice, and research. The enduring value of a public health perspective is that it applies different 'lenses' for understanding gambling behaviour, analysing its benefits and costs, as well as identifying strategies for action. Harvey A. Skinner (160, p. 286)

Adolescent↗