1. Gambling in Massachusetts: At-Risk Populations & Public Health
Alissa Mazar, PhD
Social and Economic Impacts of Gambling in Massachusetts
University of Massachusetts Amherst
School of Public Health and Health Sciences
April 26th 2019

2. Takeaways and Objectives
Understand public health impacts of expanded gambling in MA
Identify at-risk populations
Examine risk profiles of casino host communities
Provide recommendations to minimize harms of PG through prevention and treatment

3. Social & Economic Impacts of Gambling in MA (SEIGMA)
Initial focus was on comprehensively assessing baseline social & economic conditions in MA:
Baseline General Population Survey
Baseline Online Panel Survey
Problem Gambling Services White Paper
Baseline Real Estate Conditions
Baseline Host Community Socioeconomic Profiles
Baseline Matching Communities Comparison

4. Social & Economic Impacts of Gambling in MA (SEIGMA)
Focus in past 2 years has been to assess social & economic impacts of Plainridge Park Casino (PPC):
PPC Construction Impacts
PPC Employee Survey
PPC Operations Impacts
MASS-AT-A-GLANCE
PPC Patron & License Plate Survey
PPC Lottery Revenue Impacts
Plainville Impact report (status: release in May 2019)
Recently culminated in integrative report: Social & Economic Impacts of Expanded Gambling in Massachusetts: 2018

5. Identification and Protection of At-Risk Populations
Baseline General Population Survey (BGPS)
Using sample of 9,578 (oversampling western MA) identified % and # of At-Risk and Problem Gamblers in MA
(N ~439,000)
(N ~ 106,000)

6. Identification and Protection of At-Risk Populations
Baseline General Population Survey (BGPS)
Most PGs in MA:
Identify as Male
72.3%
Greater Boston residency
72.0%
Identify as White
63.9%
< High School Education
60.8%
Age 25-54
58.2%
< $50,000 HH Income
54.8%
Employed
53.4%

7. Identification and Protection of At-Risk Populations
Baseline General Population Survey (BGPS)
Assessed MA population awareness of
media messages to prevent problem gambling (41%) and as function of demographics
prevention programs at work, school, and/or community (13%) and as function of demographics
Assessed % of problem gamblers wanting help (13%), seeking help (<2%), and utilizing out-of-state casino self-exclusion (24%)
Provided information to all participants about gambling and mental health treatment services in their local area

8. Identification and Protection of At-Risk Populations
In-Depth Analysis of Predictors of PG in MA
Risk of PG is different from prevalence. Multivariate analysis of BGPS data shows risk of PG highest in:
report most of their friends & family to be gamblers
engage in daily lotteries
identify as Black
gamble at casinos
identify as male
gamble online
other behavioral addictions
high school or less educational attainment
not born in the US

9. Identification and Protection of At-Risk Populations
Baseline Online Panel Survey
5,046 online panelists recruited same time as BGPS (2013/2014) which assessed more MA problem gamblers to better understand:
nature and prevalence of negative impacts (functional impairment)
impacts of different types of gambling
prevention awareness and treatment seeking

10. Identification and Protection of At-Risk Populations
Baseline Online Panel Survey
Negative Impacts/Functional Impairment
Gamblers
Problem Gamblers
Financial Problems
3.8%
54.2%
Health & Stress-Related Problems
49.6%
Mental Health Problems
3.2%
31.4%
Relationship Problems
1.1%
13.7%
Work/School Problems
<1%
9.3%
Illegal Activity
0.5%
8.4%

11. Identification and Protection of At-Risk Populations
Baseline Online Panel Survey
Type of Gambling Causing Most Problems for PGs
Only 26.6% reported specific type most problematic
Level of prevention awareness for PGs
47.4% aware of media messages
31.8% aware of programs at work, school, or in community
Treatment seeking for PGs
25.4% wanted help for gambling problems
16.1% sought help for gambling problems (63% of people who wanted help)
24.5% entered into out-of-state casino self-exclusion agreement

12. Identification and Protection of At-Risk Populations
Problem Gambling Services White Paper
Key Findings from SEIGMA Research Activities and Potential Implications for Strategic Planners of Problem Gambling Prevention and Treatment Services in Massachusetts
Tailored to inform Strategic Plan for Services to Mitigate the Harms Associated with Gambling in Massachusetts
Based on SEIGMA research findings, 43 prevention and treatment implications for strategic planning were identified

13. Identification and Protection of At-Risk Populations
Baseline Targeted Population Surveys of the 3 H&SCs
Plainville &SC
Everett &SC
Springfield &SC
Any gambling
79.8%
67.9%
74.3%
All lottery
66.4%
55.4%
64.7%
Traditional lottery
63.2%
51.8%
61.1%
Instant games
40.8%
31.4%
43.4%
Daily games
12.1%
14.2%
15.3%
Raffles
36.6%
25.0%
33.1%
Casino out-of-state
23.2%
22.0%
23.9%
Sports betting
14.8%
13.6%
11.6%
Private betting
13.7%
13.3%
9.9%
Horse racing
5.3%
5.1%
2.4%
Bingo
3.2%
3.3%
4.0%
Online
2.0%
3.1%
1.5%

14. Identification and Protection of At-Risk Populations
Baseline Targeted Population Surveys of the 3 H&SCs
Plainville &SC
Everett &SC
Springfield &SC
Non-Gambler
19.8%
31.7%
25.3%
Recreational Gambler
70.9%
56.5%
62.3%
At-Risk and Problem Gambler
9.3%
11.8%
12.4%

15. Identification and Protection of At-Risk Populations
Baseline Targeted Population Surveys of the 3 H&SCs
At-Risk & Problem Gambler Characteristics
Plainville &SC
Everett &SC
Springfield &SC
Gender
male
Race/Ethnicity
Black or Hispanic
Education
< high school
< graduate school
Income
< $50K HH income
Age
18-34 & 35-49
35-49
18-34 & 50-64

16. Identification and Protection of At-Risk Populations
Plainville Baseline Economic Profile; Everett Baseline Economic Profile; Springfield Baseline Economic Profile
2013
Plainville
Everett
Springfield MA
Household Income
$77,109
$49,368
$34,311
$66,866
< High School
25.9%
59.4%
55.7%
36.4%
Limited English Proficiency
0.4%
17.5%
12.8%
5.8%
Unemployment Rate
8.4%
7.3%
11.1%
7.1%
Poverty Rate
5.5%
13.2%
29.4%
11.4%

17. Identification and Protection of At-Risk Populations
Follow-up Targeted Population Survey of Plainville H&SC
No significant change in PG or At-Risk Gambling in Baseline Targeted Population Survey (BTPS) of Plainville in 2014 to Follow-Up (FTPS) in 2016

18. Identification and Protection of At-Risk Populations
Follow-up Targeted Population Survey of Plainville &SC
No significant change from BTPS-Plainville to FTPS-Plainville in % of regular gamblers reporting negative impacts due to gambling

19. Identification and Protection of At-Risk Populations
Key Informant Interviews of GA in Plainville Area
“We have had GA meetings here [Plainville United Methodist Church] for approximately 20 years.  At present about 15 people attend these meetings each week.  We have not seen any increase in attendance since Plainridge [Casino] opened.“ (Secretary for NE Gamblers Anonymous, Mar 7, 2018).

20. Identification and Protection of At-Risk Populations
Comorbidity and Health Care Services for Pathological Gamblers in MA
Using the Massachusetts All-Payer Claims Data (CHIA) it was determined that patients with diagnosis of pathological gambling had:
High rates of comorbid anxiety disorders (28%), mood disorders (26%), and substance use disorders (18%)
Much higher rates of care from social workers and psychologists (except when having 3 or more comorbid diagnoses)

21. How can the Existing Research Results be Operationalized to Minimize Harm?
Need to significantly increase public awareness of prevention and treatment as overall awareness is too low, especially among at-risk and problem gamblers

22. How can the Existing Research Results be Operationalized to Minimize Harm?
Educational prevention campaigns could target:
Groups/Areas with lowest awareness:
Young people
Students
Identify as female
Identify as non-white (Hispanic, Black, Asian)
Greater Boston & SE MA

23. How can the Existing Research Results be Operationalized to Minimize Harm?
Educational prevention campaigns could target:
Groups with highest risk of becoming PGs:
report most of friends & family to be gamblers
engage in daily lotteries
identify as Black
gamble at casinos
identify as male
gamble online
other behavioral addictions
high school or less educational attainment
not born in the US

24. How can the Existing Research Results be Operationalized to Minimize Harm?
Educational prevention campaigns could target:
Geographic regions at greatest risk of negative impact:
Springfield &SC
Everett &SC

25. How can the Existing Research Results be Operationalized to Minimize Harm?
Treatment awareness and outreach could:
Target groups with largest number of PGs:
Identify as male
Greater Boston residency
Identify as White
< High School Education
Age 25-54
< $50,000 HH Income
Employed

26. How can the Existing Research Results be Operationalized to Minimize Harm?
Treatment awareness and outreach could:
Increase availability and prominence of self-help materials, in recognition that a large majority of those experiencing problem gambling in MA indicate they do not wish outside help

27. How can the Existing Research Results be Operationalized to Minimize Harm?
Educational campaigns and treatment outreach are optimally devised and implemented in conjunction with the local community:
Greater awareness
Greater ‘buy-in’—use of services
Greater effectiveness
Greater satisfaction

28. For more information, visit:
@ImpactsMa