BNET Business Network, November 1, 2008

GAMES, GAMBLING, AND CHILDREN: APPLYING THE PRECAUTIONARY PRINCIPLE

[Rachel's introduction: Since the potential for both real gambling, addiction, and other negative health and social consequences is clear, it should be incumbent on those who promote such activities to provide scientific evidence that they do not have unintended outcomes- with one or repeated exposure. This calls for application of the "precautionary principle" -- where the burden of proof is on those who promote actions that have the potential to damage the environment or health.]

By Adnan A. Hyder and Nicholas H. Juul

TOPIC: We were compelled by the trends of Internet gambling, state- initiated gambling outlets, and of having gambling social events in middle schools and high schools in the United States to examine gambling and its health effects on children and adolescents.

PURPOSE AND SOURCES: We researched trends in adolescent gambling as well as its association with negative health and sociological outcomes through the literature for child and adolescent gambling studies.

CONCLUSION: The literature shows gambling to be associated with many negative health and socioeconomic effects. The increasing participation of children and adolescents is of particular concern, for the earlier a person starts gambling, the more likely that person is to develop serious gambling problems. We propose the application of the precautionary principle in this situation. Until it is proven that adolescents will not be negatively affected by exposure to gambling, the exposure of adolescents to gambling must be carefully restricted.

Imagine a child arriving at school at an unusual time, the evening, to see the cafeteria and gymnasium bedecked in glamorous streamers and signage, tables with cards and felt upon them, teachers and parents wearing top hats and sequin vests, and bedazzled classmates running around. The student is given a certain amount of fake money and is told that at the end of the night, the fake money will buy lottery tickets for prizes such as Gameboys and iPods. The goal is to play all of the card games and roulette that she can and earn more fake money so that she can then buy more lottery tickets for the iPod she has always wanted. Although she is not holding real money, she feels the excitement in the uncertainty of gambling, the sophistication of the feel of risk-taking. All of this with the friendly faces of parents, teachers, and classmates.

This staking of something of potential financial value on an uncertain outcome is indeed gambling, and it is a practice that researchers are finding to be increasingly familiar to children and adolescents in the United States and Canada. Research conducted between 1984 and 1999 shows a trend of increasing overall gambling, as well as problem gambling, among adolescents (Jacobs, 2000). While in the late 1980s and early 1990s the prevalence of pathological adolescent gambling was about 6%, in 2005, a study conducted in the Midwestern United States found a prevalence of 10% (Fisher, 1993; Lesieur & Klein, 1987; Magoon & Ingersoll, 2005; Winters, Stinchfield, & Fulkerson 1993). These studies were primarily focused on adolescent age subjects, but for many children gambling starts much earlier. Gupta and Derevensky reported in 1998 that gambling was a common activity among those even younger-as early as 8 years of age.

Such a young start is disturbing because researchers have also shown that the earlier a person starts gambling, the more likely it is that he or she will develop problematic gambling behavior (Fisher, 1993; Griffiths, 2003; Gupta & Derevensky, 1998; Huxley & Carroll, 1992; Winters et al., 1993). It is intuitive that if a person with some degree of predisposition to addiction is exposed to an addicting agent at a more vulnerable time (an earlier age), that person will be more likely to develop a full-blown addiction. Starting earlier along the path of addiction will not only make one more likely to develop that addiction, but it will also increase the persistence of the addiction and the potential severity of the consequences of the addiction (Gupta & Deverensky; Lynch, Maciejewski, & Potenza, 2004; Vitaro, Wanner, Ladouceur, & Brendgen, 2004).

Evolutionary pressure has led to most species, humans included, having some level of risk-taking behavior; an individual who takes some risks will outcompete one who takes none. This risk-taking behavior, such as dabbling with potential addictions, varies over the life of a human, risk-loving being very high in teenage years and leveling out through a person's 20s (D. Bishai, personal communication, January 21, 2006). It is this systematic change of personality that justifies society putting constraints on the risk-taking behavior of teens. When people have reached their 20s, they can identify better what they may become addicted to; they are more familiar with the consequences of forming addictions; and their risk-taking behavior is no longer at that least- controllable, teenage peak. As a 15-year-old, a person will have no way of knowing that he or she may, as a 25-year-old, horribly regret having taken up an addicting behavior at the more vulnerable age of 15.

The social and economic consequences of problem gambling in adolescence are similar to, but perhaps even more damaging than, those experienced by adult gamblers. Adolescent problem gamblers are known to use their lunch money, steal, and sell drugs to finance their addiction (Arcuri, Lester, & Smith, 1985). Many studies have found a strong correlation between delinquency and gambling behavior (Barnes et al., 2005; Chalmers, 2005; Winters et al., 1993). Not surprisingly, poor academic performance is also highly correlated with gambling activity (Winters et al.). Hence, a typical gambling addict reaches adulthood with low grades, a criminal record, and, therefore, little prospect of attending college. Studies have also found that adolescent gambling has a connection with crime and unemployment in adulthood (Borrell, 1999).

Research has demonstrated associations between adolescent gambling and a host of negative health consequences as well. At least one study has found cigarette smoking to be highly correlated with adolescent gambling (Fisher, 1993). Alcohol and drug use have consistently been found to correlate with gambling (Barnes et al, 2005; Chalmers, 2005; Fisher; Lynch et al., 2004). In 1998, Gupta and Derevensky found adolescent gambling to be associated with mental health outcomes, including depressive symptoms, anxiety, and an increased risk of suicide ideation and attempts.

The early onset of gambling addiction certainly points to its potential classification as a gateway addiction, yet there is not nearly the same attention given to the issue as that given to smoking, alcohol, or drug use (Westphal et al., 1997). The number of pathological gamblers increases with the accessibility of gambling activities; the rise in popularity of poker and the constant, voluble presence of state-run lottery and Internet gambling will continue the increase in pathological gambling that was seen through the 1980s and 1990s. At a time when gambling is on the rise and there is little being done in the media and in schools to address the issue, it is important to limit adolescents' exposure to gambling and protect them from its potentially devastating effects.

The exposure of children to gambling-like activities, games of chance with fake money, and play with materials of potential financial value should be seen as risks that need to be controlled. Whereas it is difficult to prove that gambling in adolescence leads to other addictive behavior (i.e., to distinguish causation in the correlations mentioned above), the research cited in this paper gives reason for concern that gambling is a gateway addiction or perhaps an enhancer of existing addictive behavior. Since the potential for both real gambling, addiction, and other negative health and social consequences is clear, it should be incumbent on those who promote such activities to provide scientific evidence that they do not have unintended outcomes-with one or repeated exposure. This calls for application of the "precautionary principle" -- where the burden of proof is on those who promote actions that have the potential to damage the environment or health (O'Riordan & Cameron, 1994). The precautionary principle has been applied to many situations in which the public's health has been at risk, from marijuana use to injury prevention (Irala, Ruiz-Canela, & MartinezGonzalez, 2005; Pless, 2003). In fact, this is not the first call to apply this principle to gambling addiction (Borrell, 2001).

While policy-makers may be blinded by the popularity and economic success of gambling in recent years, we must not let them remain unaware of what continued open exposure of gambling to adolescents can mean for future generations. It is in the best interests of the children and adolescents in our society that we require institutions and individuals promoting gambling and its precursors to provide clear evidence that the health and welfare of our children will not be affected in the short or the long term. Until then, we must strive to protect our children from potential harm and recognize the links between games of chance and addictive gambling. Our schools, from elementary through high school, should discontinue the practice of having "casino" nights and instead educate their populations about the potential hazards of gambling as they have educated them about other addictive behaviors.

==============

Adnan A. Hyder, MD, MPH, PhD, is Associate Professor, Department of International Health and Berman Institute of Bioethics, fohns Hopkins Bloomberg School of Public Health, Baltimore, MD; Nicholas H. Juul, is Research Assistant, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

References

Arcuri, A. F., Lester, D., & Smith, F. O. (1985). Shaping adolescent gambling behavior. Adolescence, 20, 935-938.

Barnes, G. M., Weite, J. W., Hoffman, J. H., & Dintcheff, B. A. (2005). Shared predictors of youthful gambling, substance abuse, and delinquency. Psychology of Addictive Behaviors, 19(2), 165-174.

Borrell, J. (1999). Values in gambling research and implications for public policy. eCommunity: International Journal of Mental Health and Addiction, 1(1). http://www.ecommunity-journal.com/issues/issue/1/1

Borrell, J. (2001). Youth and problem gambling. VLGA Gambling Research Newsletter, 2(1), 6-9.

Chalmers, H. (2005). A comprehensive examination of adolescent gambling. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66(3-B), 1710.

Fisher, S. (1993). Gambling and pathological gambling in adolescents. Journal of Gambling Studies, 9(3), 277-288.

Griffiths, M. D. (2003, October). Instant-win products and prize draws: Are these forms of gambling? Electronic Journal of Gambling Issues, Issue 9.

Gupta, R., & Derevensky, J. L. (1998). Adolescent gambling behavior: A prevalence study and examination of the correlates associated with problem gambling. Journal of Gambling Studies, 14(4), 319-345.

Huxley, J., & Carroll, D. (1992). A survey of fruit machine gambling in adolescents. Journal of Gambling Studies, 8(2), 167-179.

Irala, J., Ruiz-Canela, M., & Martinez-Gonzalez, M. A. (2005). Causal relationship between cannabis use and psychotic symptoms or depression. Should we wait and see? A public health perspective. Medical Science Monitor, 11(12), 355-358.

Jacobs, D. F. (2000). Juvenile gambling in North America: An analysis of long term trends and future prospects. Journal of Gambling Studies, 16(2-3), 119-152.

Lesieur, H. R., & Klein, R. (1987). Pathological gambling among high school students. Addictive Behaviors, 12, 129-135.

Lynch, W. J., Maciejewski, P. K., & Potenza, M. N. (2004). Psychiatric correlates of gambling in adolescents and young adults grouped by age at gambling onset. Archives of General Psychiatry, 61(11), 1116-1122.

Magoon, M. E., & Ingersoll, G. M. (2005). Parental modeling, attachment, and supervision as moderators of adolescent gambling. Journal of Gambling Studies, 30, 1-22.

O'Riordan, T., & Cameron, J. (1994). Interpreting the precautionary principle. London: Earthscan.

Pless, I. B. (2003). Expanding the precautionary principle. Injury Prevention, 9, 1-2.

Vitaro, F., Wanner, B., Ladouceur, R., & Brendgen, M. (2004). Trajectories of gambling during adolescence. Journal of Gambling Studies, 20(1), 47-69.

Winters, K. C., Stinchfield, R., & Fulkerson, J. (1993). Patterns and characteristics of adolescent gambling. Journal of Gambling Studies, 9(4), 371-386.

Copyright Nursecom, Inc.