Gambling Article

Young adults’ gambling and its association with

mental health and substance use problems

Abstract Mohammad R. Hayatbakhsh

Objective: To examine the socio-
School of Population Health, University of Queensland
demographic characteristics of young
Alexandra Clavarino
adults’ gambling and its association with
mental health and substance use behaviour.
School of Pharmacy, University of Queensland
Methods: The study is based on 3,512
Gail M. Williams
young adults (1648 males) for whom data
from the Mater-University of Queensland School of Population Health, University of Queensland
Study of Pregnancy (MUSP) were
William Bor
available on self-report gambling, gambling
expenditure, Achenbach’s Young Adult Self Mater Children’s Hospital, Queensland
Report and substance use at the 21-year
follow-up of the MUSP. The participants’ age Jake M. Najman
ranged between 18.2 and 23.6 (mean = School of Population Health, University of Queensland
20.6, standard deviation = 0.8) years.

Results: Two-fifths of the young adults
reported gambling. Males reported more
money spent on gambling and were
significantly more likely to be at risk of
problem gambling. Gambling and problem
gambling were significantly more common
in less-educated individuals, those who had
higher income or those who had a paid job.
Individuals who reported gambling were
more likely to smoke cigarettes, drink more
than a glass of alcohol per day, use illicit
drugs, or exhibit high levels of externalising
behaviour than non-gamblers.
Conclusions: The findings confirm the
high prevalence of gambling and gambling
expenditure in young adults. Individuals
who are involved in gambling are more
likely to report cigarette smoking, alcohol
consumption, and use of illicit drugs. There
is a need for further research to explore
the mechanisms of association between
gambling behaviour and individuals’ mental
health and substance use.
Implications: Substance abuse and mental
health services are recommended to
consider co-morbid gambling problems in
treatment-seeking patients.
Key words: young adult, gambling, problem
gambling, mental health, substance use
Aust NZ J Public Health. 2012; 36:160-6
doi: 10.1111/j.1753-6405.2011.00815.x
R
ecent decades have witnessed a
significant increase in the prevalence
of gambling and gambling problems
in young adults.1-4 In Australia, between
1991/92 and 2004/05, annual gambling
expenditure (player losses) rose from
$7.3 billion to $16.9 billion in real terms.5
Although a lot of research has been reported
on the prevalence and correlates of gambling
in adults, there is a shortage of evidence about
the characteristics of adolescent and young
adult gamblers. Research has shown that
onset of gambling in adolescence and early
adulthood is associated with greater gambling
involvement in adulthood.6 The objectives of
this study are based on the need to increase
our understanding of gambling behaviour
and its association with psychopathology and
substance use disorders in a population of
young adults. Such information may help key
stakeholders, including those in the gambling
health services and government agencies.
Research indicates that between 70% and
90% of adults have gambled at some time in
their lives.7,8 These rates are similar to those
Submitted: March 2011 Revision requested: May 2011
Correspondence to: Dr Mohammad R. Hayatbakhsh, University of Queensland,
School of Population Health, Herston Road, Herston, Queensland 4006;
e-mail: m.hayatbakhsh@uq.edu.au
reported for adolescents,9 suggesting that
gambling behaviour begins relatively early
in life.10 It is believed that the relaxation of
gambling legalisation in most countries has
been associated with an increase in gambling
activity as well as problem gambling.8,11 The
Australian Federal Government Productivity
Commission8 exhaustively reviewed national
and international research, and estimated
that around 2.1% of the adult Australian
population have moderate to severe problems
with their gambling. In a critical analysis of
prevalence rates of problem gambling across
different developed countries, including
Australia, Walker and Dickerson12 indicate
current problem gambling involves 1-2% of
the adult community. More recent studies in
Australia have indicated that less than 1% of
the adult population is affected by problem
gambling.1,13 The difference in the prevalence
estimates in these studies could be due to
the definition and measurement of problem
gambling or the time at which problem
gambling was estimated.
International studies have shown that
Accepted: June 2011

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Gambling
gambling behaviour is more common among males, those with
a lower level of education,1,7,12-14 and people who have a paid job
and higher income.1 Some research has found that the prevalence
of gambling and problem gambling are greater in unmarried
individuals,1,15 while others suggested the opposite.7
The adverse effects of uncontrolled gambling on individuals,
their families and entire social systems are considered of growing
concern to the community and public health.16-18 One of the strongest
relationships consistently found in the literature associates problem
gambling with some of the most common mental health disorders,
such as depression, anxiety and substance use disorders.14,19-22
Gambling problems correlate with depression, anxiety and suicide
in both adolescents and adults.23-31 The Queensland Household
Gambling Survey (QHGS) in 2006-07 found that approximately
72% of problem gamblers report having felt seriously depressed
in the previous year, with 39% having been under a doctor’s care
for stress-related issues.1 Alcohol and drug abuse are perhaps the
best-documented co-morbid diagnoses for problem gamblers.20,23,24,32
Among a large national sample from the United States, in a 2001-02
survey, it was found that three-quarters of pathological gamblers
also had an alcohol use disorder, 38% had a drug use disorder
and 60% were affected by nicotine dependence.19 The QHGS also
found that while only 22% of recreational gamblers report smoking
cigarettes, more than 60% of people in the problem-gambling group
were smokers.1 Problem gamblers have consistently been found
to be substantially more likely to exhibit high levels of antisocial
behaviours and use illicit drugs than non-problem gamblers.33,34
However, most of these findings have been derived from studies
based on adults.
Notwithstanding considerable evidence in the existing literature
about substantial risk gambling and gambling problems, most
studies have focused on adult gamblers.3,35 There remains a need
for further investigation into this problem among young people.2,36
This study involves the merging of specifically collected data
relating to gambling behaviour with an existing prospective data set
describing the early life course of a population sample in Brisbane.
The main contribution of this study is to describe socio-demographic
characteristics of gambling in a cohort of young people who are at
risk of gambling and substance use problems. It aims to identify
mental health problems and substance use disorders associated with
young adults’ gambling behaviour.
Methods and materials
Study sample
The data for this study have been taken from the Mater-
University of Queensland Study of Pregnancy (MUSP). The Mater
Misericordiae Mothers’ Hospital is one of two major obstetric units
in Brisbane, Australia. The project involves a 21-year longitudinal
investigation that began in 1981. Pregnant women attending their
first clinic visit (at approximately 18 weeks gestation) at the Mater
Hospital were invited to participate in the study.37,38 Over three years
(between 1981 and 1984), 8,556 consecutive pregnant women were
2012 vol. 36 no. 2 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH
© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
Young adults’ gambling, mental health and substance abuse
invited to join the study and 8,458 agreed to participate (phase 1).
Of these, 7,223 gave birth to a live singleton infant and it is this
group of mothers and offspring that constitutes the MUSP birth
cohort sample. The original cohort were from south-east Queensland
(mainly Brisbane, the Gold Coast and the Sunshine Coast) and
appeared to be representative of public obstetrical patients but
differed from private patients in a number of characteristics.38
In the 21-year survey of the MUSP, between June 2001 and
December 2004, 3,512 young adults (1,648 males) responded to
questions about gambling involvement. The Canadian Problem
Gambling Index (CPGI)39 questionnaire was attached to the main
questionnaire from mid-July 2003, resulting in data for 969 young
adults (428 male). Data collection was mainly via face-to-face
interview. Persons living outside Brisbane or who were unable
to make an appointment for a face-to-face interview completed
a mailed questionnaire and did not do the physical assessment.
Informed consent was obtained from all participants.
Measurements
Young adults’ prevalence of gambling and problem gambling,
socio-demographic information, substance use and psycho-
behavioural characteristics were assessed at the 21-year phase of
the MUSP.
Gambling and problem gambling
Prevalence of gambling among young adults was measured at
the 21-year follow-up of the MUSP by asking participants ‘Do
you spend money on gambling (e.g. buy lottery tickets, play the
pokies, go to the casino, bet on horses, dogs, etc)?’ According to
their response, young adults were divided into two groups: ‘non-
gambler’, and ‘gambler’. The second question asked about the
amount of money young adults spent on gambling per week. The
range of answers varied from zero to $500 per week. Subsequently,
participants were divided into four groups: no money spent (60%),
$1 to $6 (20%), $7 to $34 (15%), and $35 or more (5%) per week.
The self-administered CPGI39 was used to establish the prevalence
of problem gambling in young adults. The CPGI is a 31-item
questionnaire which measures problems which correspond to DSM-
IV criteria for pathological gambling40 and the South Oaks Gambling
Screen (SOGS)41 and is, therefore, considered an appropriate
measure of problem gambling for use in the general population.
The CPGI has three main sections: gambling involvement,
problem gambling assessment and correlates of problem gambling
(including familial history of gambling). It yields five categories of
gambling behaviours: no gambling, non-problem gambling, low-
risk gambling, moderate-risk gambling and high-risk (problem)
gambling. Initial studies indicate that the CPGI demonstrates good
reliability and validity.39
Within the CPGI, nine items make up a sub-scale known as the
Problem Gambling Severity Index (PGSI). The PGSI distinguishes
four gambler sub-types: non-problem, low risk, moderate risk and
problem. The non-problem group is further divided into gamblers
and non-gamblers as these sub-types are believed to display different
161
Hayatbakhsh et al.
characteristics. Tabulation of the nine items is as follows: a score of
1 for each response of ‘sometimes,’ a score of 2 for each response
of ‘often’ and a score of 3 for each ‘always’ response. Based on
this scoring procedure, a respondent’s index can range from 0 to
27 and the cut-off points for each gambler sub-type are as follows:
0 = non-problem gambler; 1-2 = low risk gambler; 3-7 = moderate
risk gambler; and 8 or higher = problem gambler.
Socio-demographic factors
The participants’ educational level was categorised as did not
complete high school, completed high school, completed tertiary,
including college (e.g. business, trade, secretarial, teachers) and
TAFE, and university degree. A separate question asked about
education; options were: no, full-time and part-time. Marital status
was either married/de-facto relationship or unmarried (including
single, divorced and separated). Level of income was divided into
three groups: low income (up to 25th percentile), middle income
(between 25th and 75th percentiles) and high income (highest 25
percentiles). The participants were grouped into a dichotomous
variable: paid job and no paid job, according to whether they had
a paid job at the time the survey was conducted
Substance use
The extent of smoking by young adults was assessed via the
average number of cigarettes smoked per day during the week
preceding the survey (non-smokers, fewer than 10 cigarettes
per day and 10 or more cigarettes per day). Regarding alcohol
consumption, the participants were divided into three groups: no
alcohol use, up to one drink (glass) per day, and more than one
drink per day.
Consumption of illicit drugs was assessed from a self-report
questionnaire. The illicit drugs under study included cannabis,
amphetamines (amphetamine and ecstasy), heroin, cocaine,
inhalants and hallucinogens. Young adults were asked two separate
questions regarding consumption of cannabis. The first question
was ‘in the last month how often did you use cannabis, marijuana,
pot, etc?’ Options included: have never used, use every day, use
every few days, used once or so and not used in last month. In the
analysis, young adults were grouped into three categories: never
used, occasional users (including ‘once or so’ and ‘not in the last
month’), and frequent users (including ‘every day’ and ‘every few
days’). The participants’ use of other illicit drugs during the last 12
months was categorised as ‘never used’ and ‘ever used’.
Psycho-behavioural factors
In the present study, the young adult’s symptoms of problem
behaviours during the last six months were measured using the
Young Adult Self-Report (YASR), version of the Child Behaviour
Checklist (CBCL).42 The YASR is a questionnaire for individuals
aged 18-30 years which contains 114 problem items that can be
scored on eight syndromes, including externalising behaviours
(such as delinquency and aggression), internalising behaviours
(such as withdrawal behaviours, anxiety and depression), symptoms
162 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH
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Article
of social problems, attention problems and thought problems.43,44.
For the purpose of this study, YASR internalising and externalising
behaviours were selected as measures of the young adult’s mental
health. For both variables we used the 90th percentile as a cut-
off, above which were considered the cases with high levels of
externalising and internalising behaviours.45
Statistical analysis
Frequencies and cross-tabulations were used to describe gambling
practices, gambling expenditure and sub-types of gambling in young
adults. We also explored socio-demographic characteristics of young
adults who participated in the survey. Chi-square analyses were used
to test cross-sectional associations between gambling practice and
various mental health and substance use factors. Logistic regression
models examined the association of gambling behaviour and other
factors (expressed in odds ratio) that were significantly associated
with gambling.
Of 969 young adults who had data available on the CPGI, 41.4%
gambled at 21 years; of those 30.1% were non-problem gamblers
(NPG), 6.3% were categorised as low-risk gamblers, 3.8% as
moderate-risk gamblers, and just over 1.0% met the criteria for
problem gambling (or high-risk gamblers). Due to the small number
of participants, the low, moderate and high-risk problem gamblers
were combined into one group. This did not substantially change the
pattern of results. In this study, the combined low, moderate and high
risk gamblers are called ‘at risk and problem’ gamblers (ARPG).
This group constituted 11.3% of the cohort of young adults.
Results
Of 3,512 (1,648 male and 1,864 female) young adults, 76.9%
had a paid job (44.5% full-time), while 23.1% reported no paid
job. Nearly 23.0% of the participants were studying full-time and
another 12.0% were in part-time study. The overall prevalence of
young adult gambling and a demographic profile of gamblers and
non-gamblers are outlined in Table 1. Some 40.1 % (44.2% males
and 36.6% females) of the participants reported gambling. Male
participants reported higher amounts of money spent on gambling.
In addition, male participants were significantly more likely to be
NPG and ARPG compared with females.
Less-educated individuals were significantly more likely to
gamble than respondents holding tertiary and university degrees.
Those who didn’t complete high school were also likely to spend
greater amounts of money on gambling than those who had higher
education. Middle and high incomes were associated with greater
gambling expenditure. Having a paid job and a higher level of
income were associated with both gambling and at risk or problem
gambling. Young adults who did not have a paid job were less likely
to be NPG and more likely to be ARPG. By contrast, those with high
incomes were more likely to gamble and to be ARPG than lower
income earners; the highest proportion of ARPG was observed
among individuals who reported higher income compared to others.
Young adults who were married or living in de facto relationships
2012 vol. 36 no. 2
Gambling Young adults’ gambling, mental health and substance abuse

Table 1: Gambling and young adult socio-demographic characteristics.

Variables N Gambling Gambling expenditure (dollars per week) Problem Gambling Severity Index
No Yes p* None <7.0 7.0-34.9 35.0+ p* NG NPG ARPG p*
Gender <0.001 <0.001 % % % <0.001
Male 1,637 55.8 44.2 55.8 16.2 20.9 7.1 426 50.9 34.3 14.8
Female 1,875 63.4 36.6 63.4 21.9 12.8 1.9 543 64.6 26.9 8.5
Education completed <.001 <0.001 NS
Incomplete high school 715 52.9 47.1 52.9 14.3 23.6 9.2 183 53.0 29.5 17.5
Completed high school 1,873 61.5 38.5 61.4 20.6 14.7 3.3 492 60.8 30.1 9.2
Tertiary education 781 62.1 37.9 62.1 19.5 15.7 2.7 237 59.1 30.4 10.6
University 143 62.2 37.8 62.2 25.9 9.1 2.8 57 56.1 31.6 12.3
Paid job <0.001 <0.001 <0.01
Yes 2,702 57.8 42.2 57.8 20.0 17.6 4.6 767 57.2 32.5 10.3
No 810 66.9 33.1 66.9 16.7 13.0 3.4 202 63.9 21.3 14.9
Income <0.001 <0.001 <0.01
Low 976 70.0 30.0 70.0 17.7 10.8 1.5 219 69.4 21.0 9.6
Middle 1,763 58.9 41.1 58.9 19.7 17.4 4.0 462 57.8 32.0 10.2
High 773 49.3 50.7 49.3 20.0 22.0 8.7 288 51.7 34.0 14.2
Marital status NS <0.05 NS
Married/de facto 572 57.7 42.3 57.7 20.1 19.1 3.1 266 54.9 35.0 10.1
Single/separate 2,760 60.5 39.5 60.5 19.0 15.8 4.7 703 60.0 28.3 11.7
Note: * p value derived from Chi-square tests; NG non-gambler; NPG no-problem gambler; ARPG at risk and problem gambler; NS non-significant.

Table 2: Association of young adults’ gambling, substance use and mental health.
Variables Gambling Gambling expenditure ($ per week) Problem gambling severity index
No Yes p* None <7.0 7.0-34.9 35.0+ p* NG NPG ARPG p*
(2,103) (1,409) (2,103) (676) (581) (152) (568) (292) (109)
% % % % % % % % %
Cigarette smoking (per day) <0.001 <0.001 <0.001
Non-smoker 69.2 55.6 69.2 65.7 48.5 38.2 69.7 62.0 39.5
<10 per day 16.1 19.4 16.1 17.9 21.3 18.4 17.1 17.1 19.3
10+ per day 14.7 25.0 14.7 16.4 30.1 43.4 13.2 20.9 41.3
Alcohol consumption <0.001 <0.001 <0.001
Abstainer 11.3 4.1 11.3 3.4 4.5 5.3 11.1 5.1 5.5
≤1 drink per day 59.2 47.3 59.2 59.8 39.2 22.4 59.9 50.0 35.8
>1 drink per day 29.5 48.7 29.5 36.8 56.3 72.4 29.1 44.9 58.7
Cannabis ever used <0.001 <0.001 <0.001
No 55.0 42.9 55.0 47.9 40.8 28.3 55.1 51.0 27.5
Yes 45.0 57.1 45.0 52.1 59.2 71.7 44.9 49.0 72.5
Pattern of current cannabis use <0.001 <0.001 <0.001
No use 55.0 42.9 55.0 47.9 40.8 28.3 55.1 51.0 27.5
Occasional use 35.3 41.2 35.3 40.4 41.5 43.4 35.7 38.4 45.9
Frequent use 9.7 16.0 9.7 11.7 17.7 28.3 9.2 10.6 26.6
Use of other illicit drugs <0.001 <0.001 <0.001
No 77.1 68.9 77.1 74.7 66.8 51.3 74.8 72.6 54.1
Yes 22.9 31.1 22.9 25.3 33.2 48.7 25.2 27.4 45.9
Internalising NS NS NS
Normal 90.1 89.9 90.1 89.1 90.9 90.1 89.6 90.8 84.4
Top 10% 9.9 10.1 99.9 10.9 9.1 9.9 10.4 9.2 15.6
Externalising <0.001 <0.001 <0.001
Normal 92.8 88.0 92.8 89.5 89.2 77.0 94.0 89.0 74.3
Top 10% 7.2 12.0 7.2 10.5 10.8 23.0 6.0 11.0 25.7
Notes: * p value derived from chi-square tests; NG non-gambler; NPG no-problem gambler; ARPG at risk and problem gambler; NS non-significant.

2012 vol. 36 no. 2 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 163
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Hayatbakhsh et al. Article

were only slightly less likely to spend money on gambling activities
than those who were separated or single.
The association between young adults’ gambling behaviour and
substance use and mental health is presented in Table 2. Gambling
was associated with cigarette smoking, alcohol consumption,
use of illicit drugs and externalising behaviour. Individuals who
gambled were more likely to smoke cigarettes, drink more than
one glass of alcohol per day, use cannabis or other illicit drugs
and exhibit a higher level of externalising behaviour. Similarly,
gambling expenditure was associated with the use of legal and
illegal substances and externalising behaviour. Report of greater
gambling expenditure was associated with increased likelihood
of cigarette smoking, alcohol consumption, use of cannabis and
other illicit drugs and more symptoms of externalising behaviour.
Table 2 also shows that heavy smokers and drinkers of more
than one glass of alcohol per day were disproportionately over-
represented in the ARPG group. A higher proportion of the ARPG
group reported having used cannabis, in particular frequent use,
and having ever used illicit drugs other than cannabis, than non-
gamblers and no-problem gamblers. Finally, ARPG were more
likely to manifest extreme levels of externalising behaviour. By
contrast, there appears to be no association between young adults’
internalising and gambling problems.
Individuals who reported gambling or problem gambling were
more likely to smoke cigarettes, use cannabis or use other illicit
drugs (Table 3). There was a direct relationship between amount
of money spent on gambling and frequency of substance use. For
example, participants who spent between $7 and $35 per week on
gambling were nearly three times more likely to smoke 10 or more
cigarettes per day (OR = 2.9; 95% CI: 2.3-3.6), while for those
who spent more than $35 the association was significantly stronger
(OR = 5.3; 95% CI: 3.7-7.8). The data in Table 3 illustrate a similar
pattern for the association of gambling and use of other legal and
illegal substances. Further, it is noted that young adults who reported
non-problem or problem gambling were statistically significantly at
increased risk of reporting high levels of externalising behaviour.
Discussion
Gambling is an emerging public health problem with remarkably
little known about the onset of gambling behaviour over the early
life course. In this study, we examined the profile of young adult
gambling, gambling expenditure and ARP gambling in Brisbane,
Australia. We found that 40.8% of young adult respondents had
participated in at least one gambling activity. Males were more
likely (44.2%) than females (36.6%) to gamble. Those with higher
incomes constituted a greater proportion of the gambling group and
individuals with a higher level of education (tertiary education and
university) were less likely to gamble relative to the less-educated
groups. We also found that gambling activity was associated with
young adults’ concurrent substance use. An increased quantity of
cigarettes smoked and illicit drug use was related to greater risk of
engagement in gambling activities. In addition, young adults who
reported having gambled or had problem gambling were more

Table 3: Association of young adults’ gambling, substance use and mental health.
Variables Gambling Gambling expenditure Problem Gambling Severity
(dollars per week) Index
No Yes None <7.0 7.0-34.9 35.0+ NG NPG ARPG
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Cigarette smoking (per day)
Non-smoker Ref Ref Ref Ref Ref Ref Ref Ref Ref
<10 per day Ref 1.5 (1.3-1.8) Ref 1.2 (0.9-1.5) 1.9 (1.5-2.4) 2.1 (1.3-3.3) Ref 1.1 (0.8-1.7) 2.0 (1.1-3.5)
10+ per day Ref 2.1 (1.8-2.5) Ref 1.2 (0.9-1.5) 2.9 (2.3-3.6) 5.3 (3.7-7.8) Ref 1.8 (1.2-2.6) 5.5 (3.4-8.9)
Alcohol consumption
Abstainer Ref Ref Ref Ref Ref Ref Ref Ref Ref
≤1 drink per day Ref 0.4 (0.3-0.6) Ref 0.3 (0.2-0.5) 0.6 (0.4-0.9) 1.2 (0.6-1.7) Ref 0.6 (0.3-1.0) 0.8 (0.3-2.0)
>1 drink per day Ref 2.1 (1.8-2.4) Ref 1.2 (1.1-1.5) 2.5 (2.4-3.5) 6.5 (4.4-9.6) Ref 1.8 (1.4-2.5) 3.4 (2.2-5.2)
Cannabis ever used
No Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes Ref 1.6 (1.4-1.9) Ref 1.3 (1.1-1.6) 1.8 (1.5-2.1) 3.1 (2.2-4.5) Ref 1.2 (0.9-1.6) 3.2 (2.1-5.1)
Pattern of current cannabis use
No use Ref Ref Ref Ref Ref Ref Ref Ref Ref
Occasional use Ref 1.5 (1.3-1.7) Ref 1.3 (1.1-1.6) 1.6 (1.3-1.9) 2.4 (1.6-3.5) Ref 1.2 (0.9-1.6) 2.6 (1.6-4.2)
Frequent use Ref 2.1 (1.7-2.6) Ref 1.4 (1.0-1.9) 2.5 (1.9-3.3) 5.7 (3.6-8.9) Ref 1.3 (0.8-2.0) 5.8 (3.2-10.5)
Use of other illicit drugs
No Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes Ref 1.5 (1.3-1.8) Ref 1.1 (0.9-1.4) 1.7 (1.4-2.0) 3.2 (2.3-4.5) Ref 1.1 (0.8-1.5) 2.5 (1.7-3.8)
Externalising
Normal Ref Ref Ref Ref Ref Ref Ref Ref Ref
Top 10% Ref 1.8 (1.4-2.2) Ref 1.5 (1.1-2.0) 1.6 (1.2-2.1) 3.9 (2.6-5.8) Ref 1.9 (1.2-3.2) 5.4 (3.1-9.4)
Notes: NG non-gambler; NPG no-problem gambler; ARPG at risk and problem gambler

164 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2012 vol. 36 no. 2
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Gambling
likely to display externalising behaviour (including aggression and
delinquency).
Our findings are largely consistent with previous research,
including the QHGS.1 In addition, the data in this study confirms
other research that suggested gambling behaviour begins relatively
early in life9 and that current problem gambling involves 1-2% of
the community.12 The present study also supports previous research
that indicated an association between gambling problems on one
side and psychopathology, including substance use disorder on the
other.19,21,46 However, our data contradict the findings of those studies
that suggest an association between anxiety and depression disorders
and gambling problems. One possible reason for this discrepancy
could be due to the different methods in assessment of mental
health problems. Unlike McCormick and colleagues31 and Petry
and colleagues,19 we used self-reported symptoms of internalising
problems assessed by YASR.
Notwithstanding the existing literature on the association
between gambling problems and psychopathology and substance use
disorders, there remain questions that require further investigation:
What is the cause-effect sequence? Does problem gambling precede
or follow (or occur at the same time) as mental health and substance
abuse? Due to simultaneous collection of data on both gambling
and mental health problems, our study does not have the capacity to
address the issue of cause and effect association, although it suggests
that involvement in problem gambling is associated with greater
legal and illegal substance use and problem behaviour.
Limitation
A few limitations should be taken into account when interpreting
the findings of this study. First, the present study had a sizeable
reduction in the sample between the first antenatal visit and the
21-year follow-up. Of the 7,223 participants who were included
in the original cohort (1981-83), only 48.6% responded to the 21-
year follow-up. Attrition in this study was more common among
males and those from a lower socio-demographic background.38
Our observed associations could vary if the association between
gambling, mental health and substance use in those lost to follow-
up was higher or lower than in the study group. In addition, we
only had data on CPGI for 969 young adults. This might have led
to some of the associations between problem gambling, and mental
health and substance use behaviour becoming statistically non-
significant. Finally, this study was conducted between 2001 and
2004. Since then, access to the gambling facilities has increased
and age of initiation to gambling has declined. However, there is
no reason to believe that this study’s findings cannot be inferred to
the present time.
Conclusion
Some 40.1% of respondents were gamblers and 11.3% met
the CPGI criteria for problem gambling with 4.8% of the sample
being moderate or high risk problem gamblers. The data in this
study points to high rates of gambling and gambling expenditure
2012 vol. 36 no. 2 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH
© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
Young adults’ gambling, mental health and substance abuse
in young adults. With the increase in access to gambling services, it
is clear that many young adults now engage in gambling behaviour
and a substantial minority develop problem gambling.1 Individuals
who are involved in gambling, and in particular those who spend
more on gambling, are more likely to report cigarette smoking,
alcohol consumption, use of illicit drugs and exhibit high levels of
externalising behaviour. It is recommended that substance abuse and
mental health services consider co-morbid gambling problems in
treatment-seeking patients. There is a need for research to explore
the mechanisms of association between gambling behaviour and
individuals’ mental health and substance use.
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