1. Hispanic Gamblers and the CPGTSP Outpatient Program Michael Campos, Ph.D. UCLA Gambling Studies Program Phone: 310.825.6427 E-mail: mdcampos@mednet.ucla.edu

2. 2010 Census Data (Ennis et al., 2011) 2006 California Problem Gambling Prevalence Survey Data (Volberg et al., 2006) 2012 Outpatient CPGTSP Program Demographic and Utilization Data (UGSP 2013)

3. Definition of Hispanic 2010 Census: “Hispanic or Latino” refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

4. Diversity of the Hispanic Population Country of origin Racial background Reasons for immigration Length of time in U.S. Generational Status Language Preference Acculturation

5. U.S. Demographic Trends 308.7 million people resided in the U.S. in 2010. 50.5 million (16%) were of Hispanic origin. Increase from 35.3 million (13%) in 2000 Represents the majority of growth in the total population. Between 2000 and 2010 the Hispanic population grew by 43% which was 4 times the national growth rate.

6. U.S. Demographic Trends Three quarters of Hispanics reported being of Mexican, Puerto Rican, or Cuban origin. Mexican origin = 63% Puerto Rican = 9% Cuban = 4%

7. U.S. Demographic Trends Population Increases among other Hispanic groups: Salvadoran = 152% Guatemalan = 180% South Americans = 105% Dominicans = 85%

8. California Demographics CA population = 37,253,956 CA Hispanic population = 14,013,719 37.6% of CA residents were Hispanic Majority (81%) were Mexican origin or heritage CA ranks first in population for 4 of 7 Hispanic groups

9. Hispanic Population by County

10. Key Points Hispanics are a large and growing segment of the population. The majority of Hispanics in the US are of Mexican origin or heritage, but trends show increasing diversity within the Hispanic population. In California, Hispanics comprise over 1/3 of the total population, with the large majority being of Mexican origin or heritage.

11. Culture and Mental Health A patient’s cultural background may influence Description of symptoms Meaning imparted to illness Causation and prevalence for some disorders, but not others Coping styles Treatment seeking Stigma A clinician’s cultural background may influence Communication Diagnosis Conceptions of Mental Illness Assumptions about what a clinician is (and is not) supposed to do Source: Mental Health: Culture, Race, and Ethnicity, SAMHSA, 2001

12. Gambling Among U.S. Hispanics Few nationally representative samples Others sampled from Texas, New Mexico, Florida, Minnesota All cross-sectional surveys or interviews General areas of studies: Epidemiology Help Line Usage Co-morbidities

13. Prevalence of Gambling Problems Studies show elevated prevalence rates for problem or pathological gambling among Hispanics relative to Non-Hispanic Caucasians (Stinchfield, 1997; Welte et al., 2001; Westermeyer et al., 2005)

14. Help Seeking for Gambling Problems Source: Caudrado, 1999

15. Key Points Few studies have examined gambling among Hispanics and for the most part they have focused on epidemiology. Most studies show increased prevalence of gambling problems among Hispanics relative to Non-Hispanic Caucasians. Help seeking for gambling problems among Hispanics is lower than that of Non-Hispanic Caucasians.

16. CA Prevalence Survey Data

17. Gambling Problem Grouping Assessed using the NODS (Gerstein et al., 1999). Used the same four groups as in the CA Problem Gambling Prevalence Survey Final Report: Non-Gambler/Non-Problem Gambler At-Risk (1 to 2 NODS items endorsed) Problem (3 to 4 NODS items endorsed) Pathological Gambler (5 or more NODS items endorsed)

18. Prevalence of Gambling Problems ** p < 0.01

19. Prevalence of Gambling Problems by Gender Note: Percentages with different superscripts are significantly different at p < 0.05 or less.

20. Preferred Games for Past Year Gamblers * p < 0.05; ** p < 0.01 ** *

21. Preferred Games for Past Year Male Gamblers ** * * p < 0.05; ** p < 0.01

22. Preferred Games for Past Year Female Gamblers ** * p < 0.05; ** p < 0.01

23. Key Points Problem, but not pathological gambling, is higher among Hispanics relative to Non-Hispanics, particularly among males. Past year gambling is lower among Hispanic females relative to Non- Hispanic females. Counter to expectations, we did not see a preference for action oriented games among Hispanic males.

24. Spanish Speaking Gambling Treatment Providers

25. Gambling Problem Prevalence by CA Region Red = 4.5% Yellow = 4.3% to 4.5% Green = 3.7% to 4.3% Blue = 2.0% to 3.7%

26. Spanish Speaking CPGTSP Providers

27. CPGTSP Outpatient Data

28. Sample Used The sample was limited to English Speaking, US Born, Non-Hispanic Caucasians and Hispanics 62.1% of Hispanics spoke a language other than English at home and 39.8% of Hispanics were born outside the US All data comes from Intake and In Treatment Forms

29. Top Referral Sources Non-Hispanic Caucasian Hispanic Helpline (1-800- GAMBLER) 220 (39.1)102 (63.4) GA or Gam-Anon69 (12.3)8 (5.0) California Council on Problem Gambling 40 (7.1)14 (8.7) Family/Friend48 (8.5)7 (4.3) Healthcare Professional49 (8.7)5 (3.1) Former Client39 (6.9)6 (3.7)

30. Demographics

31. Key Points Relative to Non-Hispanic Caucasians, Hispanics were Younger More likely to be male Less educated Trended towards being more likely to be married No statistical differences for income or employment.

32. Age, Gender, Marital Status Non-Hispanic Caucasian Hispanict-value or X 2 p-value Mean (SD) Age49.5 (13.3)44.5 (13.4)4.170.000 N (%) Male341 (56.6)105 (65.2)3.840.050 N (%) Marital Status Divorced150 (24.9)23 (14.3)9.790.081 Separated38 (6.3)15 (9.3) Widowed28 (4.7)7 (4.3) Cohabitation33 (5.5)8 (5.0) Now Married207 (34.4)66 (41.0) Single/Never Married 146 (24.3)42 (26.1)

33. Education Non-Hispanic Caucasian HispanicX2X2 p-value < High School48 (8.0)36 (22.4)44.600.000 High School77 (12.8)39 (24.2) Some College288 (47.8)63 (39.1) Bachelor’s Degree 127 (21.1)16 (9.9) Grad/Prof Degree 62 (10.3)7 (4.3)

34. Employment Non-Hispanic Caucasian HispanicX2X2 p-value Full Time295 (49.0)96 (59.6)6.080.108 Part Time87 (14.5)18 (11.2) Unemployed (SW) 83 (13.8)20 (12.4) Unemployed (NSW) 137 (22.8)27 (16.8)

35. Income Non-Hispanic Caucasian HispanicX2X2 p-value < $9,99950 (8.3)13 (8.1)2.410.121 $10,000 to $14,99937 (6.2)14 (8.7) $15,000 to $24,99975 (12.5)15 (9.3) $25,000 to $34,99974 (12.4)24 (14.9) $35,000 to $49,99974 (12.4)29 (18.0) $50,000 to $74,999132 (22.0)36 (22.4) $75,000 to $99,99956 (9.3)17 (10.6) $100,000 to $149,99964 (10.7)10 (6.2) $150,000 to $199,99917 (2.8)1 (0.6) $200,000 and Above20 (3.3)2 (1.2)

36. Gambling Behavior

37. Gambling Activities

38. Gambling Locations Most frequently cited location for gambling was at a casino. Relative to Non-Hispanic Caucasians, Hispanics Were more likely to gamble at a casino Equally likely to report gambling at other locations (e.g., track, OTB, Friend’s/Family Home, Internet, etc.)

39. Gambling Problem Severity

40. Key Points Relative to Non-Hispanic Caucasians, Hispanics Trended towards slightly higher NODS scores Experienced problems sooner after starting to gamble Entered treatment sooner after experiencing a problem Trended towards being more likely to owe money to family or friends Multivariate analysis indicated that ethnicity was not associated with problem severity, rather, current age, age of first gambling experience, time to first problem after initiating gambling, and having an Axis I disorder were.

41. Duration and NODS scores Mean (SD)Non-Hispanic Caucasian Hispanict-valuep-value Age First Gambled 25.8 (12.3)27.1 (12.2)-1.130.257 Years to First Problems 17.3 (13.8)13.6 (12.2)3.010.003 Years to Treatment 12.9 (13.5)9.5 (11.6)3.110.002 Mean NODS score 8.08 (1.8)8.38 (1.7)-1.870.062

42. Legal Problems Due to Gambling

43. Gambling Debt Non-Hispanic Caucasian Hispanict-value or X 2 p-value Mean (SD) Log of Total Debt 9.29 (1.9)9.02 (1.5)1.460.104 Any Casino Debt 62 (10.3)15 (9.3)0.130.713 Any Credit Card Debt 186 (30.9)56 (34.8)0.890.347 Any Family/Friend Debt 156 (25.9)54 (33.5)3.700.054 Any Other Debt 112 (18.6)39 (24.2)2.530.112

44. Substance Use

45. Psychiatric Comorbidity Non-Hispanic Caucasian HispanicX2X2 p-value Mood181 (33.5)30 (18.6)12.970.000 Anxiety105 (19.4)19 (11.8)4.940.026 ADHD20 (3.7)1 (0.6)4.050.044 Psychotic18 (3.3)1 (0.6)3.450.063 Personality6 (1.1)2 (1.2)0.020.889 Any Axis I Disorder 233 (43.0)41 (25.5)16.030.000

46. Medical Comorbidity Non-Hispanic Caucasian HispanicX2X2 p-value Ucler5 (0.9)3 (1.9)0.970.324 Obesity36 (6.7)10 (6.2)0.040.842 Hypertension76 (14.0)26 (16.1)0.440.507 Heart Disease26 (4.8)5 (3.1)0.850.357 Diabetes42 (7.8)18 (11.2)1.850.173 Cancer9 (1.7)1 (0.6)0.960.327 Liver Disease4 (0.7)2 (1.2)0.370.543

47. Significant Predictors of Problem Severity VariableBetat-valuep-value Age0.213.100.000 Age First Gambled -0.36-4.790.000 Time to First Problem -0.12-2.110.036 Any Axis I Disorder 0.1313.080.002 F [16, 540] = 16.75, p < 0.000; R 2 = 0.16

48. Treatment

49. Key Points Relative to Non-Hispanic Caucasians, Hispanics Are more often entering treatment for the first time Waited about the same time to enter treatment Spent a bit more time in treatment, but had slightly fewer sessions Multivariate analysis suggested that ethnicity was not related to number of visits, rather, age and intake NODS scores were.

50. Prior Treatment Experience Chi-Square = 12.21, p < 0.01

51. Wait for Treatment

52. Time in Treatment and Number of Sessions

53. Predictors of Number of Visits VariableBetat-valuep-value Age0.142.540.011 Intake NODS Score 0.112.600.010 F [16, 668] = 9.12, p < 0.013; R 2 = 0.045