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The family exclusion order as a harm-minimisation measure for casino gambling: the case of Singapore
Abstract
Singapore is one of the first jurisdictions in the world that has implemented a harm minimization model based on third party exclusion known as the Family Exclusion Order (FEO). Unlike other forms of third party exclusion practiced in other countries, family members in Singapore are able to apply for FEOs to prevent a gambler from entering the casinos, if the family has experienced harm caused by his/her gambling. In this study, 105 applicants for the FEO were sampled from all successful FEOs granted within a five-year period. Using a qualitative approach, this study attempts to illuminate the intricate issues experienced by family members that provided the impetus for them to apply for the FEO. While the extant literature posits self-exclusion as a superior tool of restraint as it involves the gambler’s personal motivation to curb gambling, this paper reports initial evidence of benefits resulting from family-imposed restraints from the perspective of family members. In particular, positive ratings of the FEO stemmed from a sense of relief experienced by mother and wife applicants. Possible reasons behind these positive outcomes are explicated using intrinsic motivation theory, with sensitivity to gender relations within the family.
... Nineteen studies examined gender, and 5 of these found no difference between men and women (Bergh & Kuhlhorn, 1994;Browne et al., 2018;Browne et al., 2019;Castren et al., 2018;Goh et al., 2016). Despite this, several studies showed that men have a higher prevalence of harms than women ( Raisamo et al. (2015) found that men gamble more frequently and spend more money when gambling. ...
... Despite this some studies suggested differences in how gambling harms present between genders. In Singapore, Goh et al. (2016) reported that "tentative evidence… points to the risk of child neglect when the problem gambler is the mother." They also found that verbal abuse was most commonly males towards their mother but found no difference in cases of physical abuse between genders. ...
... Similarly, Hing et al. (2014) reported that participants were betting above their means, felt the need to spend more, borrowed or sold, and had health problems. Goh et al. (2016) found that families in Singapore were at risk of acute financial harms when the problem gambler was a parent, with households suffering double financial harms through loss of income and debt. When the gambler was a mother without income, they found that the father would leave employment to care for the children, resulting in an income reduction for the entire household. ...
Internet Gaming Disorder (IGD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a potential disorder in 2013. The condition has been widely studied by researchers; however, there are many who criticise and debate the validity of this diagnosis and its symptom criteria.
This thesis began by taking a comparative approach to the debate, where IGD was compared against established addiction disorders to find commonalities that may justify its inclusion under the umbrella of addiction. Some similarities were found between IGD, gambling, and substance use disorders. The variables were all related to cognitive instability, an aspect of impulsivity, and a two-factor model of impulsivity was found that was similar to factor models previously reported for substance use and gambling. It was concluded that while commonalities do exist, the factor predicting maladaptive gaming was opposite to the predictor of gambling and substance use. This suggested a significant difference, prompting the question, how else can we establish whether gaming might be disordered?
To address this question the thesis took a new approach following the work of Loftus and Loftus. They wrote that a behaviour that is not good for the individual may be disordered; in other words, the harmful outcomes of behaviour outweigh the benefits. The key aim of this thesis was therefore to create a comprehensive list of potential outcomes from gaming. The taxonomy was developed and tested, and all but one of the listed items was endorsed by at least one participant. Over ¼ of the sample reported more harms than benefits, with the most common being lost time, irritability, and sleep changes. This work could support future research and practical developments in measures and treatments of IGD. However, further development of the taxonomy, such as weighted items, would be beneficial.
... Finally, although there is evidence that intrinsic motivation is critical to the adoption of responsible gambling strategies, gamblers' families' distress and disapproval can also act as motivations for behavior modification [45]. The Family Exclusion Order, another alternative to self-exclusion, has also been perceived as an effective intervention [46]. The Family Exclusion Order is a third-party exclusion model in which relatives can obtain barring orders for family members that cause harm due to gambling behaviors or addiction [46]. ...
... The Family Exclusion Order, another alternative to self-exclusion, has also been perceived as an effective intervention [46]. The Family Exclusion Order is a third-party exclusion model in which relatives can obtain barring orders for family members that cause harm due to gambling behaviors or addiction [46]. Family Exclusion Order has been shown to reduce familial conflicts, as well as to lower gambling. ...
... However, similar barriers and limitations apply. The major limiting factor described by Goh et al. [46] is the lack of multi-venue exclusion programs, which lead to continued gambling in other venues. Even though self-exclusion may seem to better an individual's volition, family exclusion can also help addicted individuals increase intrinsic motivation and nurture familial relationships [46]. ...
Gambling disorder is a major public health issue in many countries. It has been defined as a persistent, recurrent pattern of gambling and is associated with substantial distress or impairment, lower quality of life, and living with a plurality of psychiatric problems. Many people suffering from gambling disorder seek help in ways other than formal treatment seeking, including self-management strategies. One example of responsible gambling tools that has gained popularity in recent years is self-exclusion programs. Self-exclusion entails individuals barring themselves from a gambling venue or a virtual platform. The aim of this scoping review is to summarize the literature on this topic and to explore participants’ perceptions and experiences with self-exclusion. An electronic literature search was conducted on 16th May 2022 in the following databases: Academic Search Complete, CINAHL Plus with Full Text, Education Source, ERIC, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, APA PsychInfo, Social Work Abstracts, and SocINDEX. The search yielded a total of 236 articles, of which 109 remained after duplicates were removed. After full-text reading, six articles were included in this review. The available literature shows that although there are many barriers and limitations to the current self-exclusion programs, self-exclusion is generally viewed as an effective responsible gambling strategy. There is a clear need to improve the current programs by increasing awareness, publicity, availability, staff training, off-site venue exclusion, and technology-assisted monitoring, as well as by adopting more holistic management approaches to gambling disorders in general.
... Nineteen studies examined gender, and 5 of these found no difference between men and women 43,50,57,59,63 . ...
... Despite this some studies suggested differences in how gambling harms present between genders. In Singapore, Goh et al. 63 reported that "tentative evidence… points to the risk of child neglect when the problem gambler is the mother." They also found that verbal abuse was most commonly males towards their mother, but found no difference in cases of physical abuse between genders. ...
... Goh et al. 63 found that families in Singapore were at risk of acute nancial harms when the problem gambler was a parent, with households suffering double nancial harms through loss of income and debt. When the gambler was a mother without income, they found that the father would leave employment to care for the children, resulting in an income reduction for the entire household. ...
Background: Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency. Primary and Secondary Outcome Measures: Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 3) not available as a full article.
Methods: We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.
Results: A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.
Conclusion: Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.
... Nineteen studies examined gender, and 5 of these found no difference between men and women 43,50,57,59,63 . ...
... Despite this some studies suggested differences in how gambling harms present between genders. In Singapore, Goh et al. 63 reported that "tentative evidence… points to the risk of child neglect when the problem gambler is the mother." They also found that verbal abuse was most commonly males towards their mother, but found no difference in cases of physical abuse between genders. ...
... Goh et al. 63 found that families in Singapore were at risk of acute nancial harms when the problem gambler was a parent, with households suffering double nancial harms through loss of income and debt. When the gambler was a mother without income, they found that the father would leave employment to care for the children, resulting in an income reduction for the entire household. ...
Background: Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.
Primary and Secondary Outcome Measures: Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 3) not available as a full article.
Methods: We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.
Results: A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.
Conclusion: Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.
... Browne et al. 56 found that although younger age appeared to correlate with harm this was not statistically signi cant, and 43 reported that guilt was not associated with age. Goh et al. 57 found that verbal abuse was most common from young males, however older males were more likely to coerce money from their spouse. ...
... Nineteen studies examined gender, and 14 of these found evidence that harms affected men and women differently, compared to 5 that found no difference 40,48,54,56,57 . Several studies showed that men have a higher prevalence of harms than women 39, 41-44, 46, 47, 52, 55 , however Canale et al. 39 and Raisamo et al. 43 found that men gamble more frequently and spend more money when gambling. ...
... Despite this some studies have suggested key differences in how gambling harms present between genders. In Singapore, Goh et al. 57 reported that "tentative evidence… points to the risk of child neglect when the problem gambler is the mother." They also found that verbal abuse was most commonly males towards their mother, but found no difference in cases of physical abuse between genders. ...
Background: Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and play frequency.
Primary and Secondary Outcome Measures: Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 3) not available as a full article.
Methods: We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.
Results: A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.
Conclusion: Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.
... Goh et al. 57 found that verbal abuse was most common from young males, however older males were more likely to coerce money from their spouse. ...
... Nineteen studies examined gender, and 14 of these found evidence that harms affected men and women differently, compared to 5 that found no difference 40,48,54,56,57 . Several studies showed that men have a higher prevalence of harms than women 39, 41-44, 46, 47, 52, 55 , however Canale et al. 39 and Raisamo et al. 43 found that men gamble more frequently and spend more money when gambling. ...
... Despite this some studies have suggested key differences in how gambling harms present between genders. In Singapore, Goh et al. 57 reported that "tentative evidence… points to the risk of child neglect when the problem gambler is the mother." They also found that verbal abuse was most commonly males towards their mother, but found no difference in cases of physical abuse between genders. ...
Background: Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and play frequency.
Primary and Secondary Outcome Measures: Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 3) not available as a full article.
Methods: We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.
Results: A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.
Conclusion: Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.
... Further, during the exclusion period, many gamblers continued gambling by visiting casinos in neighbouring jurisdictions [53]. In a study of a TPE program based in Singapore, families reported financial and nonfinancial harms as motivation for applying for a TPE [55]. Participants who considered the TPE effective described a sense of relief and improved family finances and relationships. ...
... Third-party exclusion 3 [32,54,55] Not enough research to draw conclusions. However, like voluntary exclusion, studies reported that violations of exclusion orders were not uncommon. ...
The harms accompanying disordered gambling are well documented. Additionally, there is growing attention to the harms that arise from people who gamble heavily but do not meet the criteria for a gambling disorder. Accordingly, there has been an increasing interest in the effectiveness of consumer protection tools for consumers of gambling products. Subsequently, there is a need to properly evaluate the evidence for their effectiveness. This review aimed to conduct a narrative synthesis of empirical studies to identify gaps, weaknesses, and strengths in the existing evidence for the effectiveness of harm minimisation tools available to people who gamble. This review includes studies published between January 2015 to July 2022 and comprises 55 peer-reviewed studies for final synthesis. Findings reveal that while more research is needed to examine the effectiveness of active and passive consumer protection tools, uptake of tools is low in part because users view them as tools for individuals already experiencing gambling harm as opposed to protective tools for all users. Research is needed to determine effective ways of communicating the value of consumer protection tools for gambling.
... The National Council on Problem Gambling (NCPG) in Singapore conducts surveys triennially, with the most recent report for the year 2020 indicating that probable pathological gamblers constituted approximately 0.02% to 0.4% of the respondents [61]. Both problem gamblers and their family members have been able to benefit from preventive and protective services [62]. For instance, as of March 2017, a total of 285,024 legal orders had been issued barring individuals from entering local casinos (including self-exclusion orders). ...
This study investigates the persuasive mechanism of slogans employed in responsible gambling campaigns. We analyse slogans from official posters in the U.S., Singapore, and Macau, focusing on two domains. First, the Theory of Planned Behaviour is applied to examine the intention to gamble expressed in the slogans to reveal how gambling is positioned in social contexts. Second, two framing devices—i.e., conceptual metaphors and the frame of gains/losses—are examined to understand how these framing devices reinforce the persuasive message while interacting with each other. Two models of persuasion emerge from our data—one encouraged ‘grounded games’ for enjoyment, while the other discouraged gambling due to its potentially ‘harmful’ consequences. We advocate for a gestalt view on the theoretical constructs that contribute to the overall effectiveness of persuasive messaging. These constructs should be integrated into an analytical framework, with particular attention given to the framing effect of conceptual metaphors and the gain/loss frame, and their interplay.
... The review identified several qualitative studies. These tended to use small samples of very specific CSOs such as partners (Holdsworth et al., 2013;Klevan et al., 2019;Kwan et al., 2020;Patford, 2009;Riley et al., 2020), children (Darbyshire et al., 2001;Patford, 2007b;Wurtzburg & Tan, 2011), parents (Patford, 2007a), families (Mathews & Volberg, 2013), or broader groups (Goh et al., 2016;Landon et al., 2018) and tend to focus on the CSOs of gamblers in treatment. An advantage of qualitative research is the level of depth regarding the narrative experiences of CSOs that can be achieved (Turner, 2010). ...
Problem gambling can have negative impacts on both harmed gamblers, and those people close to them (concerned significant others; CSOs). Experiencing these gambling-related harms can have a significant impact on a person’s wellbeing and quality of life. Recently, the focus of research on people with gambling problems has expanded from exploring gambling-related harms and specific psychological outcomes, to include global evaluations of health and wellbeing. However, it is also important to understand the degree to which these impacts extend to CSOs. This narrative literature review presents what is known about the impact of gambling-related harms on CSOs’ wellbeing and identifies areas of future enquiry. The review identified both knowledge and methodological gaps, including that relatively little is known about impacts to CSOs’ subjective wellbeing. What is known, is confounded by different methods of identifying CSOs across studies, and the use of predominantly small, non-representative, and treatment-related samples. Addressing these gaps will lead to a greater understanding of the impact of problem gambling on the community.
... Third-party exclusion schemes encompass exclusions initiated by operators and/or by gamblers' significant others such as family members or close friends. Examples of this include New Zealand's Venue-Initiated Exclusion Order whichas in Hesseis intended to be imposed at the service provider's initiative in cases of well-founded suspicion of problematic gambling behavior (Department of Internal Affairs, 2019), Belgium's Excluded Persons Information System, which also provides a rationale for banning on the basis of judicial decisions in cases of debt (Gaming Commission, 2019), and Singapore's Family Exclusion Orders, which can be initiated by family members (Goh et al., 2016). After a test phase of several months, the use of OASIS has been mandatory since 1 April 2014 for all gaming hall operators in Hesse. ...
Since April 2014, in Hesse (Germany), it has been possible to arrange an exclusion from all gaming halls. In addition, the Hessian Gaming Halls Act obligates operators to exclude individuals who show signs of addictive gambling behavior. The objective was firstly to quantitatively analyze the administrative data set of all excluded individuals (N = 12,253). Secondly, the compliance of staff in implementing various gambler protection measures was examined. Test players visited 64 of the 750 gaming hall sites in Hesse. The findings showed that third-party exclusion accounted for only 1% of all exclusions. Checks on on-site gambler protection revealed that in 16% of all attempts of access by test players and observers, no entry checks were conducted; in 28% of the gaming halls, they were able to play despite being excluded. Furthermore, staff reacted with appropriate interventions to signs of problematic gambling behavior in 7% of cases. The low level of compliance can be explained by an inherent conflict between economic interests and an adequate protection of gamblers. Measures for improvement should include the set up of a centralized, cross-sector exclusion system, a more closely monitoring of protection measures, and the introduction of a personalized gambler identity card.
... Families in Singapore apply for help to overcome the adverse effects of gambling committed by family members [17]. In Australia, out of 120 families who have gambling problems, 52.5% report acts of family violence [18]. ...
... Another reason for selecting this combination of topics (responsible gambling, environmental protection, and money laundering prevention) for analyzing the CSDs of gambling firms is that they concern different sets of non-government stakeholders (see Table 1). Particular NGOs (Goh et al. 2016;Thompson 2015), and civil society groups such as GetUp! (Irvine and Moerman 2017) seek to prevent problem gambling and protect problem gamblers. ...
This study investigates how firms in the gambling industry manage their corporate social disclosures (CSDs) about controversial issues. We performed thematic content analysis of CSDs about responsible gambling, money laundering prevention and environmental protection in the annual reports and stand-alone CSR reports (2009–2016) of four USA-based multinational gambling firms and their four Macao counterparts. This study draws on impression management theory, camouflage theory and corporate integrity theory to examine the gambling firms’ CSDs. We infer that the CSD strategies of gambling firms in Macao and the USA did not serve as vehicles for reflexivity about social responsibility or social responsiveness. Instead, the firms camouflaged legitimacy gaps about sensitive topics by adopting assertive or defensive façades, disclaiming ethical responsibility, curtailing disclosure, or offering zero disclosure. Differences between CSD strategies according to topic, location, time, and reporting channel appear to reflect four factors: pressure to report, availability of good news, whether a firm was assuming ethical responsibility for addressing the topic, and the prospective readership. This study extends our understanding of the contextual and topic-specific factors affecting the quantity and character of CSDs by firms in a contested industry.
... Effective prevention would require strict control of age verification, which a licence would facilitate. Licensing might also protect families in cases of child neglect due to problem gambling through suspension: currently only Singapore allows families to request the exclusion of a family member from a gambling venue as a harm-minimisation measure (Goh, Ng, & Yeoh, 2016). ...
Licensing is currently the most popular option among regulators for controlling gambling operations. However, approximately 20% of operators are still public monopolies. Many forms of gambling (especially lotteries) are government operated even in countries with a licensing system. This creates an inherent conflict of interest, given that government is supposed to protect the well-being of its citizenry and to reap the benefits of gambling at the same time. At least in the gambling monopoly, however, addressing the unavoidable harm that results from gambling should be a priority. Industry self-regulation and reliance on “responsible gambling” rely too much on individuals to control their own gambling. It is suggested in this contribution that it is possible to provide more comprehensive consumer protection, recognising both the duty of governments to take care of their own citizens and the fact that industry self-regulation is not enough. Pre-commitment cards have been tested in various contexts, and have shown promise in terms of providing tools for individuals to restrict their own gambling. However, given the known shortcomings such as allowing the use of other cards that are not one’s own, and other venues, it is clear that in themselves they do not guarantee effective prevention. Personal licensing is therefore explored as a move forward in this literature-based discussion. Although the system may be applicable to other contexts, the focus is on the Nordic countries. Given that the underlying justification for gambling monopolies is to control gambling-related harm, in the cases of Finland and Norway licensing could be combined with loyalty cards introduced by monopoly operators. This would provide a feasible alternative to current practices of responsible gambling.
... Thus, the findings do not allow for firm conclusions to be drawn concerning the role that family members play leading up to the exclusion. As mentioned above, research into third party or specifically familyinitiated exclusion is highly limited (Goh, Ng, & Yeoh, 2016). Thus, further research into this area is required. ...
Swiss gambling legislation is unique in that it includes health concerns and obligations for gambling operators. Specifically, the operators are required to provide social measures for the prevention of problem gambling. Moreover, gamblers with financial problems must either be banned from all casinos in Switzerland or exclude themselves. This study examines the reasons that lead to the application for a voluntary exclusion. It also considers to what extent excluded gamblers circumvent their respective prohibitions. Furthermore, it aims to identify the self-reported reasons why gamblers seek to lift the exclusion. The present study is the first of its kind to examine these questions, using data provided from three Swiss Casinos. A first step in the study involved analyzing the data obtained by trained Shift Managers during interviews with 8,170 gamblers, with the interviews taking place between 2006 and 2015. An invalidated casino questionnaire, based on DSM-IV criteria, was also completed by 3,650 participants from this sample. A second step involved evaluating forms. These forms were the documents completed during interviews with 1,005 gamblers who had successfully applied to have their interdiction terminated, with the person responsible for implementing social measures completing the forms. The findings indicated that most players had found other ways to gamble, during the exclusion period. The main reason gamblers gave for wishing to remove their ban was wanting to be able to visit a casino again. The possible reasons for this discovery are discussed, alongside the benefits and drawbacks of using industry-generated data. © 2018, Centre for Addiction and Mental Health. All rights reserved.
... The majority of CSOs pursued help for themselves firstly, through self-management strategies such as talking to the gambler about how the problem was affecting them, and organizing direct debit arrangements for household bills . In addition to self-coping, CSOs sought help from a range of sources including doctors, solicitors, bank employees and clergymen (Krishnan & Orford, 2002;Lorenz & Shuttlesworth, 1983) as well as family members and friends Patford, 2009) and specialist gambling help services (Patford, 2009;Goh, Ng, & Yeoh, 2016). When approaching relatives or friends, CSOs were careful about how much and what they disclosed, fearing they might lose friends (Patford, 2009;Kourgiantakis, Saint-Jacques, & Tremblay, 2017). ...
... The majority of CSOs pursued help for themselves firstly, through self-management strategies such as talking to the gambler about how the problem was affecting them, and organizing direct debit arrangements for household bills . In addition to self-coping, CSOs sought help from a range of sources including doctors, solicitors, bank employees and clergymen (Krishnan & Orford, 2002;Lorenz & Shuttlesworth, 1983) as well as family members and friends Patford, 2009) and specialist gambling help services (Patford, 2009;Goh, Ng, & Yeoh, 2016). When approaching relatives or friends, CSOs were careful about how much and what they disclosed, fearing they might lose friends (Patford, 2009;Kourgiantakis, Saint-Jacques, & Tremblay, 2017). ...
The availability of legalized gambling products has increased over the past three decades. Though the negative personal consequences of problem gambling (PG) are well documented, a comprehensive picture of gambling-related harm from the perspective of concerned significant others (CSOs) is lacking. The aim of this systematic review was firstly, to describe the nature of existing peer-reviewed published studies from inception through to July 2018 that have directly engaged CSOs concerning gambling-related harm. Secondly, to synthesize this literature and describe the impacts of PG on CSOs; how CSOs respond to gambling-related harm; identify gaps in the literature, and provide specific directions for future research. A systematic search strategy identified 53 studies. Following the extraction of data, a meta-synthesis was conducted on the 26 quantitative, 21 qualitative and 6 mixed-methods studies. Partners are especially impacted, suffering both mental and physical health problems. Children are also particularly affected, and appear to suffer silently due to their reluctance to disclose their parental PG worries. Problem gambling treatment and counselling services should take into account the pervasiveness of the impacts of PG, and be equipped to respond appropriately to the needs of CSOs. Future research should focus on male CSOs, and CSOs associated with non-help-seeking problem gamblers.
... At times, however, the direct harm of gambling to adults at risk is not always reported, although Valentine and Hughes (2011) noted that online gamblers with problems were sometimes funding their activities by stealing from family members. Internationally, Singapore has been one the first countries to implement a harm minimization model known as the Family Exclusion Order (FEO) whereby family members are able to apply for FEOs to prevent a gambler from entering the casinos, if the family has experienced harm caused by his/her gambling (Goh, Ng and Yeoh, 2016). ...
Literature review examining the nature of gambling-related harms for adults at risk.
Background
Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.
Primary and secondary outcome measures
Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article.
Methods
We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.
Results
A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.
Conclusion
Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.
Purpose
Opportunities to gamble have boomed in the UK in recent years, since the passing of the Gambling Act 2005. The implications of this for adults with care and support needs and for safeguarding services have not been greatly investigated. The study for which the present scoping review was conducted addresses the interface of how gambling affects adults with care and support needs in England and adult safeguarding.
Design/methodology/approach
This paper reports on the scoping review which focused on adults with care and support needs and gambling-related harm. It also included literature on perpetrators who exploit adults with care and support needs to fund their or others’ gambling. The overall aims of this scoping review were to explore what is known about gambling-related harm affecting adults with care and support needs, the gaps in the evidence base, and specifically to refine the interview questions for the wider study.
Findings
There is some evidence that adults with care and support needs experience or are at risk of gambling-related harm. There is however a lack of data from safeguarding services about this affecting adults at risk and safeguarding practice and systems. A public health approach to gambling is advocated by some, as well as effective regulation and support for people who have problems with their own or others’ gambling.
Originality/value
Industry operators, practitioners and policy makers are increasingly paying attention to gambling-related harm but there is a lack of focus on adults with care and support needs or implications for adult safeguarding.
An intrinsic–extrinsic model of motivation for smoking cessation was evaluated with 2 samples (ns = 1,217 and 151) of smokers who requested self-help materials for smoking cessation. Exploratory and confirmatory principal components analysis on a 36-item Reasons for Quitting (RFQ) scale supported the intrinsic–extrinsic motivation distinction. A 4-factor model, with 2 intrinsic dimensions (concerns about health and desire for self-control) and 2 extrinsic dimensions (immediate reinforcement and social influence), was defined by 20 of the 36 RFQ items. The 20-item measure demonstrated moderate to high levels of internal consistency and convergent and discriminant validity. Logistic regression analyses indicated that smokers with higher levels of intrinsic relative to extrinsic motivation were more likely to achieve abstinence from smoking.
Using Singapore’s newly opened mega casino resorts as an example, this article illustrates how the expanding casino economy in Asia shapes, and is shaped by, an emerging mobility regime that works through the politics of exception. The coupling of mobility and exception creates a particular governing technology of tracking credibility through which mobile subjects and citizen subjects become manageable. Credibility demands that individuals must demonstrate their own rationality and capability in the exceptional space of global circulation. Exception is harnessed when logics of economic optimization and ethicalization are maintained to legitimize different processes of channeling, sorting, and bordering. They create new articulations of mobile identities and exclusion.
This study of full-time managers and professionals examined whether variables selected from theories of the psychology of gender as well as identity, boundary, and role theories explained effects of sex on work-to-family conflict and "positive spillover." Women experienced higher positive spillover than men, primarily because they were higher in femininity. Although women did not experience different levels of conflict than men, individuals who scored higher on measured family role salience, which was positively related to femininity, experienced lower levels of conflict. Role segmentation not only reduced conflict but also had the unintended consequence of reducing positive spillover.
There exists only a small number of empirical studies investigating the patterns of family violence in problem gambling populations, although some evidence exists that intimate partner violence and child abuse are among the most severe interpersonal correlates of problem gambling. The current article reports on the Australian arm of a large-scale study of the patterns and prevalence of co-occurrence of family violence and problem gambling in Australia, New Zealand and Hong Kong. The current study screened 120 help-seeking family members of problem gamblers in a range of clinical services for both family violence and problem gambling. The main results showed that 52.5% reported some form of family violence in the past 12 months: 20.0% reported only victimisation, 10.8% reported only perpetration and 21.6% reported both victimisation and perpetration of family violence. Parents, current and ex-partners were most likely to be both perpetrators and victims of family violence. There were no gender differences in reciprocal violence but females were more likely to be only victims and less likely to report no violence in comparison to males. Most of the 32 participants interviewed in depth, reported that gambling generally preceded family violence. The findings suggest that perpetration of family violence was more likely to occur as a reaction to deeply-rooted and accumulated anger and mistrust whereas victimisation was an outcome of gambler’s anger brought on by immediate gambling losses and frustration. While multiple and intertwined negative family impacts were likely to occur in the presence of family violence, gambling-related coping strategies were not associated with the presence or absence of family violence. The implications of the findings for service providers are discussed.
This paper reviewed the literature on problem gambling prevention measures, and found two problem gambling prevention models: harm reduction and responsible gambling. Problem gambling prevention measures could be classified according to the temporal sequence of before, during and after gambling. Before measures involved attempts to change misconceptions and attitudes toward gambling; they tended to have limited effect on gambling behaviors. During measures required structural changes to gambling machines, and insertion of warning messages; they tended to have mixed results in terms of gambling behaviors. After measures included relapse prevention and self-exclusion; some self-excluded gamblers returned to gambling. Future research should focus on theory, longitudinal studies, internet gambling, and cross-national research. No prevention measure seemed to be more effective than the gamblers’ motivation to control their own gambling behaviors.
Problem gambling can significantly affect the lives of concerned significant others (CSOs) of problem gamblers, especially family members, but little is known about their help-seeking activities and experiences. This paper explores help-seeking by CSOs of problem gamblers and their related motivators and barriers. A telephone interview was administered to 48 CSOs who called an Australian gambling helpline seeking assistance for themselves and/or a person with gambling problems. Key motivators for seeking help (through helplines, non-professional sources, and self-help measures) were concerns the gambling might become a major problem, negative emotions, problems maintaining normal daily activities, concerns for dependents’ welfare, and health concerns. Barriers included wanting to solve the problem on their own, and shame. Findings highlight the need to better equip CSOs to assist both the person with gambling problems towards treatment and recovery and to protect their own physical, emotional, social and financial wellbeing.
Reasons for quitting gambling were reported by two samples of problem gamblers, long-term quitters and recent quitters, using two methodologies. The participants first described their reasons for quitting in an open-ended fashion and then with a 15-item checklist. There was a fair degree of similarity between the responses of the two samples. Both groups most frequently reported that their resolution was a conscious decision, although recent quitters were more likely to report that the decision evolved over a long period of time vs. being an immediate decision. About a third of both groups described their decision as related to a specific event and involving a crisis. In both methods, negative emotions and financial concerns were most often reported. The checklist method yielded about three times as many reasons as the open-ended method. There were no gender differences in reasons although participants with a treatment history reported more reasons than those who had not sought treatment.
Clinical commentaries and research studies have described the effects of problem gambling on families, but they have usually focused on immediate rather than extended family members. To offset this bias, the present study aimed to develop a deeper understanding of the various ways in which parents and parents-in-law experience and understand adult children's gambling problems. Thirteen parents and two parents-in-law volunteered to participate in the study. Their experiences and perspectives were explored through in-depth interviews, emails and telephone discussions. Findings from the study indicate that the repercussions of an adult child's gambling may damage parents and parents-in-law financially, complicate their family relationships and erode their health and wellbeing. Implications for formal service provision are discussed.
Self-exclusion programs are required to be provided by gambling operators in many international jurisdictions in an attempt to provide an option for those who have gambling problems to avoid further gambling. However, minimal robust and comprehensive research has been conducted to evaluate the effectiveness of self-exclusion programs. There is much scope for reform and greater cohesion between jurisdictions, particularly neighbouring jurisdictions that would offer greater protection to individuals and industry bodies. This review outlines the evidence surrounding existing self-exclusion strategies, the benefits and limitations of such programs, and provides potential recommendations for an effective intervention program. Research suggests that self-exclusion programs are under-utilised by problem gamblers and are not completely effective in preventing individuals from gambling in venues from which they have excluded, or on other forms. Nonetheless, self-report indicates that self-excluders generally experience benefits from programs, including decreased gambling and increased psychological wellbeing and overall functioning. There are many areas in which existing programs could be improved, such as providing more resources for excluded individuals and reducing barriers to program entry, and more research is needed. However, self-exclusion programs are an important component of any public health strategy that aims to minimise gambling-related harms and these should be based as far as possible on empirical evidence for effective program components.
Three empirical studies related to the Chinese concept of face are reviewed to provide examples of the indigenous approach of Chinese psychology. Using the technique of paired comparison, the first study indicated that college students (who are preparing to enter the job market) feel that they "have face'' most when they do well in their academic performance, followed by being morally upright. Retirees (who have withdrawn from the workplace) feel that they "have face'' most when their children are morally upright and successful in their careers. The second study (on patterns of emotional reactions of related others to an agent's social and moral incidents) showed, first, that incidents of positive achievement were generally evaluated by college students as being experienced with a more intense feeling of having face than were incidents of positive morality, while incidents of negative morality were experienced with a more intense feeling of "having no face'' than were incidents of negative achievement. Second, for a positive incident of having face, the intensity of emotional reaction experienced by acquaintances was generally lower than that of family members. The difference was not so strong as in the negative incident of having no face. The third study (which was a cross-cultural one on cognitive distortion caused by misconduct of related others) indicated that American college students tended to adopt a consistent standard to judge the wrongness of illegal behaviours, regardless of their relationships with the transgressor. But Taiwanese college students tended to judge an illegal behaviour as more wrong when it was done by a person outside the family, while they held a more lenient attitude towards the misconduct of parents, and a similar or more harsh attitude towards their children. Research findings are interpreted in the context of Confucian tradition.
This paper discusses the key findings from the first qualitative study focused on understanding the impacts of gambling-related debt on the family and work life of problem gamblers. The paper illustrates how current research priorities marginalise the social impacts of gambling on families and communities and suggests ways in which researchers and practitioners can address the issues and impacts of gambling-related debt on individuals, families and communities. Este artículo reporta los hallazgos principales del primer estudio cualitativo para comprender los impactos familiares y laborales originados por problemas de deudas de apuestas. El presente informe también ilustra como las prioridades de investigaciones actuales marginalizan los impactos sociales en familias y comunidades y sugiere métodos en los que los investigadores y profesionales pueden abordar los impactos de deudas relacionadas con el juego de apuestas en individuos, familias y comunidades.
For every individual with a gambling problem it is estimated that somewhere between a further 5–17 other individuals are adversely affected by it. Yet, despite the fact that this claim is commonly circulated, Krishnan and Orford point out that research into effects of problem gambling on gamblers' families has been limited and has not explored family coping in detail. This paper addresses this lacunae by drawing on qualitative research with problem Internet gamblers and their significant others (partners, parents, children and siblings) to examine the processes through which problem gambling is first disclosed within, and then managed by ‘families’. The paper concludes by arguing that because problem Internet gambling is commonly contained as a secret within families to whom it is disclosed, and is ‘self-corrected’ by many of them, the issue and extent of problem Internet gambling does not become visible in the wider public domain. Para cada persona que tiene un problema con el juego se estima que al menos afecta adversamente a entre 5 y 17 individuos indirectamente. Sin embargo a pesar de que estos datos se corroboran, Krishnan y Orford destacaron que investigaciones sobre los efectos del problema con el juego en las familias de los jugadores han sido limitadas y no se han estudiado en detalle la capacidad de la familia para enfrentarse. Este artículo es para investigar sobre ese vacío con investigaciones cualitativas acerca del problema de jugar en Internet y como afecta a otros (tales como pareja, padres, hijos y hermanos), para tratar de revelar los primeros síntomas que aparecen en el problema con el juego y luego ser tratados por las familias. El artículo concluye afirmando que el hecho y el alcance del problema con el juego en Internet es habitualmente mantenido en secreto por las familias que lo sufren y que suele ser corregido por ellas mismas por lo que no se llega a ser visible en el ámbito público.
Self-exclusion is a programme utilized by the gaming industry to limit access to gaming opportunities for problem gamblers. It is based on the following principles: (1) The gaming industry recognizes that a proportion of community members gamble excessively and have difficulty controlling gambling behaviours; (2) The gaming industry has a responsibility to provide a safe gaming environment and to assist in minimizing the negative impact on individuals displaying problem gambling behaviours; (3) Individuals must accept personal responsibility for limiting gambling behaviours to affordable levels; and (4) Self-exclusion is not a treatment designed to address psychological processes. The objective of the present paper is to propose a unifying structure for self-exclusion programmes as a gateway to treatment based on a system operated by independent 'educators' whose roles and responsibilities include informing individuals of the purpose of self-exclusion, establishing links and a gateway for access to supplementary services and monitoring and reporting the effectiveness of the overall programme.
Qualitative research produces large amounts of textual data in the form of transcripts and observational fieldnotes. The systematic and rigorous preparation and analysis of these data is time consuming and labour intensive. Data analysis often takes place alongside data collection to allow questions to be refined and new avenues of inquiry to develop. Textual data are typically explored inductively using content analysis to generate categories and explanations; software packages can help with analysis but should not be viewed as short cuts to rigorous and systematic analysis. High quality analysis of qualitative data depends on the skill, vision, and integrity of the researcher; it should not be left to the novice.
Pathological gambling (PG) is widely reported to have negative consequences on marriages, families, and children. Empirical evidence is only now accumulating but when put together with anecdotal information, the extent of these problems is clear. PG contributes to chaos and dysfunction within the family unit, disrupts marriages, leading to high rates of separation and divorce, and is associated with child abuse and neglect. Divorce rates are high, not surprising in light of reports that these marriages are often abusive. Research shows that the families of pathological gamblers are filled with members who gamble excessively, suffer from depressive or anxiety disorders, and misuse alcohol, drugs, or both. Families of persons with PG are also large, a variable independently related to family dysfunction. The authors review the evidence on the impact of PG on families, marriages, and offspring, and make recommendations for future research targeting these problems.
Problem gambling has a profound impact on family members. While this has been previously documented, this paper reports on the first study to consider the extent of this impact in Asian societies where the family continues to be a very important basis for social organization. This study, based on in-depth interviews with 50 Singaporeans with a family member who is a problem or pathological gambler, examines how their financial, emotional and social well-being is impinged upon by gambling. The enormous losses of savings, property and lifestyle, the emotional tensions based on constant harassment from moneylenders, the threats of suicide by the gambler and the distancing of social networks place family members of problem gamblers in a vulnerable state. The qualitative data in this paper fleshes out the lived experience of family members and reveals the extent to which the family is mobilized in Asian societies to cope with problem gambling. While the impact of problem gambling on families is similar across societies, routine mobilization of the extended family and the greater role of public shame and embarrassment in dictating Asian families' responses underscore the need for specialized services in these societies to assist family members to better cope with the financial, emotional and social strains caused by problem gambling.
Preserving confidentiality is problematic for human service practitioners if they know that a client is seriously harming a third party or could do so in the future. The present study concerned financial harm, as generated by gambling-related theft. Clients who disclose gambling-related theft potentially create a dilemma for practitioners, who may need to consider whether they have a professional duty to warn or in other ways protect third parties who are identifiable but uninvolved in treatment. Study participants included specialist gambling counsellors, practitioners working in agencies likely to attract clients with gambling problems and students in training. Data was collected by means of an online survey. Findings reveal how practitioners construe their profession’s legal and ethical obligations when clients admit to gambling-related theft and when they personally believe that disclosure is warranted. Areas of uncertainty and disagreement have import for employing agencies, professional associations and tertiary training institutions.
Problem gambling is an important public health issue affecting
many spheres of the gambling individual’s life, including mental
health, finances, and family. The family is a topic that has been
given little attention in problem gambling research. After a comprehensive
search of the literature, this review identified and analyzed
30 empirical studies conducted between 1998 and 2013 examining
the effects of problem gambling on families, the impact of
family involvement in problem gambling treatment, or both. The
literature shows that (a) problem gambling has several adverse
effects on individuals, families and family functioning and (b)
family involvement in problem gambling treatment is linked with
better treatment outcomes and improved individual and family
functioning. Implications for research and clinical practice are
discussed.
The purpose of this study is to shed light on gambling among older adults (age 60 and above) in Singapore. A sample of 74 older adults who were participants of a community-based elderly outreach program was surveyed. The results indicate that 27% of the respondents had gambled in the past one month and their favorite gambling game was 4D. Those who gambled were found to have more free time than those who did not (64 hours per week vs. 38 hours per week). Almost all the respondents (97%) did not know where to get help for problem gambling.
This paper offers an overview of the existing literature concerning problem gambling and families and identifies gaps in current research knowledge on this topic. Relevant theoretical perspectives are outlined and the role of familial factors in the development of problem gambling is discussed. This is followed by a focused review of the effects of problem gambling on family members, specifically the spouse, children and parents. Available treatments and therapies for family members are also reviewed. The paper concludes by identifying the limitations of existing knowledge and some directions for future research on this topic.
Aims: To apply the stress‐coping‐support perspective to the study of the effects of problem gambling in the family. Specifically, to examine the ways in which family members cope and the nature and sources of support they receive. To compare coping strategies of family members of gamblers with those of individuals living with other addictive behaviour in the family. Design: Cross‐sectional interview and questionnaire study of close relatives of problem gamblers. Participants: Sixteen close family members of gamblers from separate families, mainly parents and partners. Data: Semi‐structured interview; adapted version of the Coping Questionnaire (CQ). Findings: Data from the CQ and qualitative analysis of interview data suggested considerable use of ‘engaged’ (specifically controlling) ways of attempting to cope with such problems, comparable to the use of such strategies by relatives of people with alcohol or drug problems, but little use of ‘tolerant‐accepting’ and ‘withdrawal’ ways. Interview data on the support received (or not) by family members confirmed previous research showing that relatives of people with addiction problems often feel unsupported, but particularly appreciate positive emotional and practical support for themselves and their problem gambling relatives. Conclusions: The stress‐coping‐support perspective, previously applied to families with alcohol and drug problems, also offers an appropriate framework for understanding problem gambling and the family.
Gambling is now big business in Australia and public expenditure on gambling is high. Some individuals gamble to excess with
adverse consequences for themselves and their partner. The present study targeted women who had concerns about a current or
previous partner’s gambling and employed a qualitative methodology to explore their experiences, understandings and responses.
Various recruitment strategies were used to avoid an excessive reliance on a clinical sample and to attract participants in
different walks of life. The final sample comprised twenty-three women, eleven of whom continued to maintain a marital or
de facto relationship with the gambler. Data were gathered by means of in-depth interviews and subjected to thematic analysis.
Findings from the study indicate that women are likely to be the victims and enablers of their partner’s gambling and may
also provide informal help and care. Implications for community education programs, formal services and Australian law are
discussed.
Empirical studies indicate how parental gambling affects young children, but we do not know how adult children cope when parents
develop gambling problems in middle or late life. The primary aim of this qualitative study was to explore adult children’s
experiences and perspectives in regard to late onset parental gambling. Greater knowledge is needed to inform the development
of counselling and advisory services and public policy more generally. Participants were 15 adult children whose lives had
been in some way affected by parental gambling. Data were gathered through in-depth interviews and written accounts. Findings
indicate that the problems and dilemmas created by parental gambling have the potential to impose considerable stress on adult
children and that some of these children are heavily involved in the provision of informal care. Implications for formal services
are discussed.
Foreword - Larry Culpepper Introduction - William L Miller and Benjamin F Crabtree PART ONE: OVERVIEW OF QUALITATIVE RESEARCH METHODS Primary Care Research - William L Miller and Benjamin F Crabtree A Multimethod Typology and Qualitative Roadmap PART TWO: DISCOVERY: DATA COLLECTION STRATEGIES Sampling in Qualitative Inquiry - Anton J Kuzel Participant Observation - Stephen P Bogdewic Key Informant Interviews - Valerie J Gilchrist PART THREE: INTERPRETATION: STRATEGIES OF ANALYSIS A Template Approach to Text Analysis - Benjamin F Crabtree and William L Miller Developing and Using Codebooks Grounded Hermeneutic Research - Richard B Addison Computer Management Strategies for Text Data - Alfred O Reid Jr PART FOUR: SPECIAL CASES OF ANALYSIS Approaches to Audio and Video Tape Analysis - Moira Stewart Interpreting the Interactions Between Patients and Physicians Historical Method - Miguel Bedolla A Brief Introduction Philosophic Approaches - Howard Brody PART FIVE: PUTTING IT ALL TOGETHER: COMPLETED STUDIES A Qualitative Study of Family Practice Physician Health Promotion Activities - Dennis G Willms, Nancy A Johnson and Norman A White Doctor-Caregiver Relationships - David Morgan An Exploration Using Focus Groups PART SIX: SUMMARY Qualitative Research - Ian McWhinney et al Perspectives on the Future
The reliability and validity of a self-report measure of combat exposure are examined in a cohort of male-male twin pairs who served in the military during the Vietnam era. Test-retest reliability for a five-level ordinal index of combat exposure is assessed by use of 192 duplicate sets of responses. The chance-corrected proportion in agreement (as measured by the kappa coefficient) is .84. As a measure of criterion-related validity, the combat index is correlated with the award of combat-related military medals ascertained from the military records. The probability of receiving a Purple Heart, Bronze Star, Commendation Medal and Combat Infantry Badge is associated strongly with the combat exposure index. These results show that this simple index is a reliable and valid measure of combat exposure.
To provide practical strategies for conducting and evaluating analyses of qualitative data applicable for health services researchers. DATA SOURCES AND DESIGN: We draw on extant qualitative methodological literature to describe practical approaches to qualitative data analysis. Approaches to data analysis vary by discipline and analytic tradition; however, we focus on qualitative data analysis that has as a goal the generation of taxonomy, themes, and theory germane to health services research.
We describe an approach to qualitative data analysis that applies the principles of inductive reasoning while also employing predetermined code types to guide data analysis and interpretation. These code types (conceptual, relationship, perspective, participant characteristics, and setting codes) define a structure that is appropriate for generation of taxonomy, themes, and theory. Conceptual codes and subcodes facilitate the development of taxonomies. Relationship and perspective codes facilitate the development of themes and theory. Intersectional analyses with data coded for participant characteristics and setting codes can facilitate comparative analyses.
Qualitative inquiry can improve the description and explanation of complex, real-world phenomena pertinent to health services research. Greater understanding of the processes of qualitative data analysis can be helpful for health services researchers as they use these methods themselves or collaborate with qualitative researchers from a wide range of disciplines.
Gross monthly income from work
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Firms barring foreign workers from casinos: More than 12, 000 have applied for self-exclusion, many nudged by employers. The Business Times
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Addictions: Substance abuse and problem gambling
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An expectancy-value theory approach to the long-term modification of smoking behaviour
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