Cross-national comparisons of the prevalence of gambling, problem gambling in young people and the role of accessibility in higher risk gambling: A study of Australia, Canada, Croatia and Israel

Abstract

Countries with public policies that support gambling through gambling legislation foster an environment in which gambling is socially accepted, tacitly encouraged and actively promoted. Although gambling worldwide has features in common, countries differ in terms of the nature of their gambling markets. The current study examined the role of perceived gambling accessibility in gambling behaviors and problem gambling in four different countries: Australia, Canada, Croatia and Israel. A convenience sample comprised 1787 university students aged 18–30. Gambling behaviors and problems were found to be more prevalent and gambling was perceived to be more accessible in liberalized markets (e.g. Australia, Canada and Croatia) as compared to Israel which is relatively more conservative and has more restrictive regulations. Social accessibility was perceived to be higher in those who gambled and associated with higher risk gambling, especially for women. The study highlights the potentially important role of social normalization of gambling and how supply variations can influence perceptions as well as impact gambling behavior.

Full text

Cross-national comparisons of the prevalence of gambling, problem
gambling in young people and the role of accessibility in higher risk
gambling: A study of Australia, Canada, Croatia and Israel
Belle Gavriel-Fried
1
&Paul Delfabbro
2
&Neven Ricijas
3
&Dora Dodig Hundric
3
&Jeffrey L. Derevensky
4
Accepted: 17 June 2021
#The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Countries with public policies that support gambling through gambling legislation foster an environment in which gambling is
socially accepted, tacitly encouraged and actively promoted. Although gambling worldwide has features in common, countries
differ in terms of the nature of their gambling markets. The current study examined the role of perceived gamblingaccessibility in
gambling behaviors and problem gambling in four different countries: Australia, Canada, Croatia and Israel. A convenience
sample comprised 1787 university students aged 18–30. Gambling behaviors and problems were found to be more prevalent and
gambling was perceived to be more accessible in liberalized markets (e.g. Australia, Canada and Croatia) as compared to Israel
which is relatively more conservative and has more restrictive regulations. Social accessibility was perceived to be higher in those
who gambled and associated with higherrisk gambling, especially for women.The study highlights the potentially important role
of social normalization of gambling and how supply variations can influence perceptions as well as impact gambling behavior.
Keywords Accessibility .Gambling behaviors .Liberal gambling markets
Introduction
Gambling is a social behavior that is embedded in specific
social and environment contexts (Reith & Dobbie, 2011).
Although the legitimacy and the legislation of gambling are
manifested differently according to the socio-cultural context
in which it occurs (Cosgrave & Klassen, 2001; McMillen,
2005), commercial gambling has over the last three decades
proliferated and become widely viewed as a socially accept-
able form of recreation in many countries (Banks, 2017).
International prevalence studies show that around 70% of
adults gamble at least once per year, with most studies
reporting that 2–3% of the adult population can be identified
as either problem or moderate risk gamblers at a particular
point in time (Calado & Griffiths, 2016). Much of this growth
has been driven by regulatory changes that have increased the
supply of gambling products (e.g., the legalization of slot-
machines, opening of casinos, expansion of sports betting
and online gambling). However, given that not all people
gamble and not necessarily to the same degree, there is interest
in understanding the different factors that influence people’s
involvement in gambling in different jurisdictions (LaPlante
&Shaffer,2007; St-Pierre et al., 2014).
An important factor in this context is accessibility which is
a multidimensional concept that relates to the physical, social
and cognitive influences on people’s gambling. Physical gam-
bling refers to geographic features such as the location of
gambling venues, the number of venues, social accessibility
as a function of social and cultural approval, and cognitive
accessibility refers to people’s understanding of how to gam-
ble (Hing & Haw, 2009; Moore et al., 2011). The role of these
factors is inherent in the Pathways Model (Blaszczynski &
Nower, 2002) which recognizes ecological factors such as
ease of access and the social accessibility of gambling serve
as a “gateway”to gambling, irrespective of the role of other
more specific factors (e.g., behavior or emotional vulnerabil-
ity). Similarly, situational characteristics may serve a starting
point for developing gambling problems (Griffiths, 2008).
*Belle Gavriel-Fried
bellegav@tauex.tau.ac.il
1
The Bob Shapell School of Social Work, Tel Aviv University,
69978 Tel Aviv, Israel
2
University of Adelaide, School of Psychology,
5005 Adelaide, Australia
3
University of Zagreb, Faculty of of Education and Rehabilitation,
Zagreb, Croatia
4
McGill University, Department of Psychiatry, Montreal, Canada
Current Psychology
https://doi.org/10.1007/s12144-021-02017-7

Social and environmental factors are also recognized by pub-
lic health perspectives that propose a multidimensional model
for understanding health related issues by highlighting the
external social and environmental factors that promote or im-
pede the transition from recreational gambling to problem
related gambling (Shaffer, 2003).
Empirical studies worldwide have reported a positive asso-
ciation between gambling accessibility and gambling behav-
iors and its related harm (Pearce et al., 2008;Thomasetal.,
2011; Welte et al., 2016), even though the relationship may be
slightly non-linear. For example, a recent study conducted in
the three largest statesin Australia found a positive association
between the number of gambling venues in a local geographic
area and the number of personal insolvencies in this area
(Badji et al., 2020). Another study in Australia presented a
typology of six types of gambling venues according to their
spatial and regulatory characteristics and assessed the associ-
ation to the dangers of gambling (Young et al., 2012). The
findings indicated that the proportion of problem gamblers
tends to be highest in casino populations. An early study con-
ducted in New Zealand found a positive association between
problem gambling, gambling behavior and neighborhood ac-
cess to gambling opportunities (Pearce et al., 2008). Other
studies reporting similar associations mention the complexity
inherent to measuring the relationship between accessibility
and gambling behaviors and its negative consequences. A
study conducted in all 50 states of the U.S with 2963 adults
found that individuals who live close to the casinos gamble
more than those who do not (Welte et al., 2016), although the
design of the study precluded drawing causal conclusions. A
similar study conducted in Canada suggested a positive link
between casino proximity and gambling participation
(Sevigny et al., 2008). A meta-analysis of 34 surveys conduct-
ed in Australia and New Zealand revealed interesting findings
reflecting forces that operate simultaneously - the access and
adaptation hypothesis. There was a positive association be-
tween the density of EGM’s and problem gambling (which
supports the access thesis), but over time, the prevalence of
problem gambling was found to decrease (which supports the
individual and community adaptation hypothesis) (Storer
et al., 2009). While all these findings are based on quantitative
designs, a recent study based on interviews with recovered
gamblers in Israel indicated that an EGM-free environment,
the result of a law prohibiting EGMs from operating was cited
as one of the recovery capital dimensions that helped individ-
uals with a life-time gambling disorder cope better during their
recovery process (Gavriel-Fried & Lev-el, 2020).
Logically, countries with public policies that permit multi-
ple forms of gambling through gambling legislation foster an
environment in which gambling is socially accepted, encour-
aged and actively promoted. This can lead to more gambling
and more gambling-related problems. However, until now, we
note that no studies have explored the role of international
comparisons of perceived differences in gambling accessibil-
ity and how this might be associated with variations in gam-
bling behavior or the development of gambling-related
problems.
The Present Study
Accordingly, the aim of our research was to gain insights from
four countries that either shared similarities or differences in
their regulatory history: Australia, Canada, Croatia and Israel.
The first three of these countries have highly liberalized gam-
bling markets with less restrictive laws and regulations, ready
access to slot-machines, casinos and a range of wagering
products. Both Australia and Canada have well established
markets (Abbott, 2017; Delfabbro & King, 2012), whereas
Croatia has experienced more recent and rapid growth in the
past 20 years (Ricijašet al., 2016). By contrast, Israel has a
more restricted gaming market that reflects the tension be-
tween its traditional influences and modern attributes
(Gavriel-Fried, 2015). On the one hand, the modern-liberal
position towards gambling can be seen in the statutory right
awarded to two state-regulated enterprises to run gambling
operations on its behalf. These two public gambling organiza-
tions operate in order to maximize their revenues, just as pri-
vate companies, and provide the Israeli public with a range of
gambling opportunities, whose popularity is evident in the
significant and consistent rise in the revenues of these two
bodies in recent years (Gavriel-Fried, 2015). However, under
Israeli law, the operation of a casino or other gambling venues
for recreational purposes is classified as a criminal offense -
due to social and religious arguments (Gavriel-Fried &
Ajzenstadt, 2013), and Israel still does not have the traditional
land-based gambling establishments that are typically found
in many other parts of the world (hence, for example, in 2017
the Ministry of Finance banned EGMs). This situation likely
decreases exposure of individuals to gambling venues such as
casinos or bars with EGMs, which may help them avoid
gambling.
In this study we examined the role of perceived gambling
accessibility in the development of gambling behaviors, prob-
lem gambling, in students at universities in these four different
countries. The choice of this population was motivated by a
desire to control for age and education differences, but also
because this age-group is developmentally important.
University aged students are considered to be in a develop-
mental stage termed emerging adulthood which ranges from
the late teens to the late 20s, and even thirty (Arnett, 2007;
Wilson & Love, 2018). This period of life is typically charac-
terized as an age of instability, possibilities and identity ex-
plorations in which the individual extends the period of learn-
ing and experimentation (Arnett, 2005). As result, individuals
at this stage are most prone to exploring new activities
Curr Psychol

(Sussman & Arnett, 2014) and may be more susceptible to
engaging excessively in potentially addictive behaviors.
Central to this investigation was the study of gender differ-
ences. Gender is one of the common sociodemographic char-
acteristics that has consistently shown to be associated with
differences in gambling behavior and problems in different
developmental stages (e.g., males usually start gambling at a
younger age, Delfabbro, 2000). The prevalence of gambling,
involvement, gambling problems, or disorders are consistent-
ly higher among men than women (Husky et al., 2015;Wong
et al., 2013). In term of accessibility, a study conducted in
Brazil on 3007 risk gamblers revealed that men started to
gamble earlier than women, and were at a higher risk of being
exposed to gambling and develop gambling-related problems
(Carneiro et al., 2020), and this been borne out in a number of
reviews (González-Ortega et al., 2015; Merkouris et al.,
2016). Studies have also shown that increases in the social
accessibility of gambling is linked to their appeal and in-
creases in women’s gambling involvement when gambling
venues are perceived as safer and trustworthy (Thomas
et al., 2011).
Aims and Hypotheses
This study examined whether: (a) broader regulatory
differences across countries would be reflected in differ-
ences in perceived physical, cognitive and social acces-
sibility of gambling; (b) whether differences in per-
ceived accessibility would be related to a higher risk
of gambling in different countries; and (c) the consis-
tency of gender differences observed within countries as
based on the assumption that gambling may be more or
less acceptable for women in the different cultures. The
study used a correlational design so that the principal
focus was upon the relationship between key variables
as opposed to estimating prevalence. Nevertheless, the
paper includes comparative data relating to gambling
participation to highlight differences in the gambling
habits of the different samples and to study gender dif-
ferences. It was anticipated that gambling participation
and PG would be higher in countries with more liber-
alized markets (Canada, Australia and Croatia). Our
principal correlational hypotheses were that; (1)
Gambling would be viewed as more accessible in
Canada, Australia and Croatia than in Israel; (2)
Individuals who perceive gambling to be more accessi-
blewerepredictedtobemorelikelytoreportahigher
risk of gambling (moderate risk or problem gambling as
basedontheProblemGamblingSeverityIndex);and
(3) Gambling involvement and the prevalence of higher
risk gambling would be greater in men than women in
each country.
Method
Participants
The study involved 1787 young adults aged 18–30 years (634
men; 1153 women) drawn from four countries (477 from
Australia; 542 from Israel; 535 from Croatia and 233 from
Canada). The gender profile of the sample differed across
the countries, Χ
2
(df = 3, N =1787) = 38.9, p <.001. Theper-
centage of men was as follows: 32% in Australia; 28% in
Israel; 46% in Croatia and 37% in Canada. There were also
significant age differences, F(3, 1787) = 199.6, p< .001:
Australia (M=19.6, SD =2.11); Israel (M=23.3, SD =2.8);
Croatia (M= 21.6, SD = 2.5); Canada (M= 21.0, SD = 2.4).
The Israeli students are older than students from other coun-
tries due to the army service which is compulsory in this
country (two years and eight months for man and one year
and ten months for women).
Measures
Gambling Behavior
Participants were asked how often they had engaged in differ-
ent forms of gambling in the past year. Activities included
lottery products, gaming, casino gambling, bingo, keno,
EGMs, sports or race betting and private card games. In order
to capture all types of gambling activities one of the items was
labeled as “other”. A 6-item scale was used ranging from 1 =
Never to 6 = Almost every day.
Problem Gambling Severity Index (PGSI)
Respondents completed the 9-item PGSI (Ferris & Wynne,
2001). Statements were presented using a past 12-month
time-frame with respondents providing answers on a four-
point scale ranging from 0 = ‘Never’to 3 = ‘Almost always’.
Total scores of 0 = ‘non problem gamblers’;1–2=‘low-risk
gamblers’;3–7=‘moderate risk gamblers’; and 8+ = ‘prob-
lem gamblers’. The Cronbach’s Alpha for the PGSI ranged
from .81 to .92 in four countries.
Perceived Accessibility
The Gambling Accessibility Scale (Hing & Haw, 2009)com-
prises 13 items assessing different dimensions of accessibility:
physical, social and cognitive. Physical (5 items) refers to the
geographical accessibility of gambling; social (6 items) refers
to approval from family, friends and colleagues, and cognitive
(2 items) that measures understanding and familiarity of how
the gambling products work. These items were completed by
participants who gambled at land-based venues. An example
item for physical accessibility was: “If you gamble, how easy
Curr Psychol

or difficult would it be for you to find a venue with games of
chance that is convenient to go to”. Participants were asked to
rate each item on a 4-point scale (extremely easy, quite easy,
quite difficult, extremely difficult). The Cronbach’s Alpha
values for the 3 subscales were all very good across the four
countries: .91 to .95 for Physical; .85 to .91 for Social; and .88
to .90 for Cognitive accessibility.
Perceptions of Regulation
Participants indicated the extent to which gambling is regulat-
ed in their country on a 5- point scale from 1 = Very poorly
regulated to 5 = Very well regulated.Theywerealsoaskedto
indicate whether there was: (1) Far too much gambling, (2)
Just about the right amount, (2), or (3) Too little gambling in
their country. These two items were developed for this study.
Procedure
An on-line survey, using Qualtrics software, was distributed to
students aged 18+ enrolled at five universities located in the
large cities of Adelaide, Tel Aviv, Montreal, and Zagreb. This
age group is considered to be highly familiar with online and
social media and tend to use it on a daily basis (Duggan &
Brenner, 2013). In Adelaide, first year psychology students
were offered course credit. In Israel, the survey was distribut-
ed via the Facebook pages of groups of students at Tel Aviv
University. In Canada instructors teaching large classes (250
students plus) were asked by the researchers to display a pow-
er point slide presenting the study and providing a link to the
online survey. A poster with study information and a direct
link to the online survey was posted on local university
Facebook groups at McGill and Concordia. In the University
of Zagreb, several approaches were used: (1) General infor-
mation about the study and its main goals with the link to the
study was sent to vice deans for students affairs at all faculties
and were asked to distribute the link with their students, i.e., to
distribute the link to students’official e-mails; (2) Students
associations were contacted and informed about the research
and asked to put the link to the survey on their web-sites and
social networks; (3) The instructions for the participation in
the study included an appeal asking students to share the link
with their peers. The data was collected from August 2017 to
April 2019. The study protocol was reviewed and approved by
four institutional review boards of Tel Aviv, Adelaide, Zagreb
and McGill universities.
Analytical Strategy
It was important to rule out the possibility that findings would
be confounded by age and gender differences between the
countries. Preliminary analyses indicted that age was unrelat-
ed to the principal variables in this study, so that the small
variations in age observed in the sample were unlikely to have
had any significant influence on the results. However, this was
not true of gender, so analyses are presented separately by
gender. Univariate analyses were undertaken using chi-
square and ANOVAs (confirmed using Kruskal-Wallis tests
were used when there was strong evidence of skewed data).
Logistic regression was used to examine the best predictors of
higher risk gambling behaviors (moderate and problem
gambling).
Results
General Gambling Participation
Table 1summarizes three variables: the overall percentage of
respondents reporting engagement in at least one gambling
activity in the previous 12 months and the percentage who
reported weekly participation. One analysis examines all gam-
bling activities and a second excluded lottery products. The
results are presented separately for men and women. Male
participation rates (both overall and weekly) are significantly
lower in Israel than in the other countries; with the highest
rates of participation being observed in Canada; both
Canadian and Croatian students had the highest weekly (not
lottery) participation rates, whereas Croatian respondents
were most likely to report weekly participation when lotteries
were included. Differences in overall participation were ob-
served for women, with Israeli students found to have signif-
icantly lower rates than the other countries. However, no sig-
nificant differences were observed for weekly participation.
Comparisons within countries indicated that the overall par-
ticipation rates for men were higher than for women in all
countries except Australia. Weekly participation (excluding
lotteries) was higher for women in Canada and Australia,
whereas weekly participation that included lotteries was
higher for men in all countries. In other words, men were
generally more likely to gamble overall and gamble weekly,
but this effect was not consistently observed in Australia.
Gambling on Specific Activities
Participation rates for individual activities are summarized in
Table 2. For males, differences in participation varied by ac-
tivity. EGM participation was most common in Canada, but
less common in Israel (where it is not legally permissible);
racing participation was most common in Australia and
Croatia; lottery participation was highest in Canada and
Croatia; Keno in Australia; and private card-games were most
common in Canada, Australia and Croatia, but rare in Israel.
Overall, consistent with Table 1, the results showed that Israeli
respondents reported lower levels of gambling on most activ-
ities, except for scratch tickets, bingo and sports-betting.
Curr Psychol

Analysis of the results for women indicated that Israeli women
had the lowest level of participation on all activities except for
racing, EGMs and keno. EGM, racing and keno participation
rates were highest in Australia. Further, within country com-
parisons summarized in Table 3(results of chi-squared tests)
indicate a stronger pattern of activity specific gender differ-
ences for respondents from Israel and Croatia, with the fewest
differences observed in Australia.
Table 1 Country differences in gambling participation
Australia
(n=151)
N(%)
Canada
(n=85)
N(%)
Croatia
(n=244)
N(%)
Israel
(n=154)
N(%)
Χ
2
Men
Overall 110 (72.8) 68 (80.0) 169 (69.3) 75 (48.7) 32.5***
Weekly (non lotto) 11 (7.3) 12 (14.1) 34 (13.9) 7 (4.5) 12.0***
Weekly (lotto inc) 19 (12.6) 13 (15.3) 18 (23.8) 12 (7.8) 19.9***
(n=326)
N(%)
(n=148)
N(%)
(n=291)
N(%)
(n=388)
N(%)
Χ
2
Women
Overall 212 (65.0) 92 (62.2) 148 (50.9) 102 (26.3) 124.0***
Weekly (non lotto) 11 (3.4) 3 (2.0) 41 (1.4) 6 (1.5) 3.93
Weekly (lotto inc) 12 (3.7) 4 (2.7) 9 (3.1) 8 (2.1) 1.75
Gender differences Χ
2
Χ
2
Χ
2
Χ
2
Overall 2.9 8.0** 18.6*** 25.2***
Weekly (non lotto) 3.6 13.1*** 31.7*** 4.2
Weekly (lotto inc) 13.7** 12.7*** 51.8*** 10.2***
*p<.05**p< .01 ***p<.001
Table 2 Country differences in gambling involvement in specific
activities
Australia
(n=151)
N(%)
Canada
(n=85)
N(%)
Croatia
(n=244)
N(%)
Israel
(n=154)
N(%)
Χ
2
Men
EGMs 50 (33.1) 34 (40.0) 23 (29.9) 21 (13.6) 24.2***
Racing 20 (13.2) 5 (5.9) 34 (13.9) 4 (2.6) 17.0***
Scratchies 36 (23.8) 28 (32.9) 57 (23.4) 41 (26.6) 3.4
Lottery 30 (19.9) 27 (31.8) 80 (32.8) 33 (21.4) 11.5**
Keno 16 (10.6) 7 (8.2) 7 (2.9) 8 (5.2) 10.8***
Casino tables 44 (29.1) 30 (35.3) 76 (31.1) 30 (19.5) 9.0*
Bingo 16 (10.6) 9 (10.6) 21 (8.6) 5 (3.2) 7.0
Sports 36 (23.8) 23 (27.1) 48 (19.7) 34 (22.1) 3.0
Cards 63 (41.7) 48 (56.8) 86 (35.2) 12 (7.8) 71.3***
(n= 326)
N(%)
(n=148)
N(%)
(n= 291)
N(%)
(n=388)
N(%)
Women
EGMs 121 (37.1) 31 (20.9) 26 (8.9) 39 (10.1) 110.0***
Racing 43 (13.2) 6 (4.1) 2 (0.7) 7 (1.8) 65.7***
Scratchies 80 (24.5) 41 (27.7) 78 (26.8) 60 (15.5) 17.2***
Lottery 56 (17.2) 35 (23.6) 63 (21.6) 33 (8.5) 29.5***
Keno 31 (9.5) 4 (2.7) 2 (0.7) 3 (0.8) 50.9***
Casino tables 41 (12.6) 20 (13.5) 23 (7.9) 14 (3.6) 23.8***
Bingo 41 (12.6) 19 (12.8) 32 (11.0) 10 (2.6) 29.1***
Sports 29 (8.9) 17 (11.5) 19 (6.5) 16 (4.1) 11.4***
Cards 83 (25.5) 44 (29.7) 51 (17.5) 4 (1.0) 108.8***
*p<.05**p< .01 ***p<.001
Table 3 Gender differences in gambling involvement in specific
activities within countries (Χ
2
)
Australia
(n=477)
Χ
2
Canada
(n=233)
Χ
2
Croatia
(n=535)
Χ
2
Israel
(n=542)
Χ
2
MvsF
EGMs –9.7* 38.7*** –
Racing ––37.1*** –
Scratchies –––9.1*
Lottery ––8.4* 17.2**
Keno –––10.8*
Casino tables 19.3*** 15.2** 47.5*** 37.2**
Bingo –––
Sports 10.6** 9.2* 20.9** 42.4***
Cards 12.8** 16.2** 21.9** 17.6*
*p< .05 **p< .01 ***p< .001. Only significant results are presented to
facilitate interpretation
Curr Psychol

Problem Gambling
The PGSI scores and classifications for men and women
among the entire sample separately are summarized in
Table 4. Post hoc comparisons (Fisher Least Significant
Difference Tests) applied to the results for men indicate
that total PGSI scores and the proportion of problem gam-
blers were highest in Canadian and Croatian respondents
than in the other two countries. On the other hand, among
women, total PGSI scores were highest for Australian and
Canadian respondents. In general, however, the total per-
centage of higher risk gamblers (moderate-risk and
problem gamblers combined) was lowest in Israeli respon-
dents compared with the other three groups.
Accessibility and Gambling
Table 5summarizes the mean item scores for the three acces-
sibility subscales reverse-scored so that higher scores indicate
a perception of greater accessibility. The results for men
Table 4 Country comparisons of
Problem Gambling Severity
Index (PGSI) scores and
classifications
Australia
(n=151)
N(%)
Canada
(n=85)
N(%)
Croatia
(n=244)
N(%)
Israel
(n=154)
N(%)
Χ
2
Men
Non-problem 91 (60.3) 48 (56.5) 143 (58.6) 114 (74.0)
Lowrisk 35(23.2) 15(17.6) 44(18.0) 20(13.0)
Moderate risk 20 (13.2) 13 (15.3) 38 (15.6) 12 (7.8)
Problem 5 (3.3) 9 (10.6) 19 (7.8) 8 (5.2) 19.3***
M(SD) M(SD) M(SD) M(SD) F/ KW Test
PGSI scores 1.2 (2.31) 2.4 (4.52) 2.1 (4.05) 1.2 (3.12) 3.75/ 12.1*
(n=326)
N(%)
(n=148)
N(%)
(n= 291)
N(%)
(n=388)
N(%)
Women
Non-problem 232 (71.2) 114 (77.0) 257 (88.3) 350 (90.2)
Low risk 64 (19.6) 26 (17.6) 19 (6.5) 24 (6.2)
Moderate risk 24 (7.4) 4 (2.7) 13 (4.5) 12 (3.1)
Problem 6 (1.8) 4 (2.7) 2 (0.7) 2 (0.5) 63.2***
M(SD) M(SD) M(SD) M(SD) F/KW-test
PGSI scores .77 (1.91) .68 (2.05) .35 (1.40) .26 (1.11) 7.5/ 53.6**
*p< .05 **p< .01 ***p< .001; KW = Kruskal Wallis test
Table 5 M (SD) accessibility scores by gender and country
123 4
Australia
(n=477)
M (SD)
Canada
(n=233)
M(SD)
Croatia
(n=535) M (SD)
Israel
(n=542) M (SD)
F(3, 548) Post hoc
Men
Physical 3.18 (0.60) 3.01 (0.69) 3.53 (0.57) 2.68 (0.95) 42.0*** 3> 1,2,4; 1> 4, 2> 4
Cognitive 2.93 (0.68) 3.05 (0.81) 3.26 (0.67) 2.97 (0.84) 7.0*** 3> 1,2,4
Social 2.49 (0.56) 2.62 (0.69) 2.49 (0.65) 2.29 (0.85) 3.9** 1–3>4
F(3, 896)
Women
Physical 3.27 (0.65) 2.84 (0.81) 3.53 (0.58) 2.51 (0.94) 88.1*** 3> 1,2,4; 1,2>4; 1> 2
Cognitive 2.71 (0.79) 2.71 (0.79) 3.15 (0.73) 2.63 (0.88) 20.2*** 3>1,2,4
Social 2.39 (0.64) 2.26 (0.69) 2.18 (0.66) 2.01 (0.79) 13.5*** 1> 3–4; 2> 4; 3>4
*p<.05**p< .01 ***p< .001
Curr Psychol

showed that perceptions of physical accessibility differed sig-
nificantly. Post-hoc comparisons showed that this perception
was strongest in Croatia followed by Canada and Australia
with the lowest level observed in Israel. Cognitive accessibil-
ity was higher in Croatia compared with the other three coun-
try groups. Social accessibility was lower in Israel than for the
other countries. For women, the results were similar: Croatian
women reported the highest physical accessibility followed by
Australia, with lower levels in Canada and Israel. Cognitive
accessibility was again higher in Croatia than the other coun-
tries. Social accessibility was higher among women in
Australia, Canada and Croatia than in Israel. Further analysis
revealed that those who gambled (as compared to those who
did not) scored significantly higher on social accessibility in
all four countries. No significant differences were observed
for physical accessibility and cognitive accessibility was only
higher for gamblers among Canadian respondents.
Accessibility and Higher Risk Gambling
An important question is whether greater accessibility of gam-
bling is related to a higher risk gambling. Table 6presents a
series of logistic regression analyses that examined how well
the three dimensions of accessibility predicted moderate-risk
and problem gambling for men and women by country of
residence. This analysis controlled for differences in the per-
ceived level of regulation and availability of gambling in each
country. In the Australian sample, no dimension of risk was
significant for men, but women were more likely to be higher
risk gamblers if they reported greater social and cognitive
accessibility (i.e., knew how to gamble and it was socially
acceptable). In the Israeli sample, social acceptability was
the only significant factor for both men and women. In the
Croatian sample, social accessibility was the only significant
predictor (for women only). No significant results were ob-
tained for the Canadian sample. The perception of availability
was significant in Australian women (a perception of there
being a need for more gambling was associated with higher
risk gambling). In Croatian men, a more positive appraisal of
gambling regulation was associated with higher risk gam-
bling. Overall, the results suggest that physical accessibility
is less important than the other dimensions of accessibility and
that it was more common to find that social availability was an
important factor for higher risk gambling among women.
These findings held after controlling for country, age, gender
and perceptions of regulation and availability.
Discussion
The principal aim of this study was to examine cross-country
differences in the perception of gambling accessibility and the
nature of gender differences. The results showed that country
Table 6 Accessibility as a predictor of moderate-risk/ problem
gambling in each country
Australia
Men
Variable B SE Wald OR 95% CI
Regulation .19 .27 < 1 1.21 .71–2.06
Availability .01 .53 < 1 1.01 .36–2.87
Physical (A) −.22 .42 < 1 .80 .35–1.81
Cognitive (A) .22 .39 < 1 1.24 .58–2.66
Social (A) .50 .46 1.19 1.65 .67–4.08
Constant −3.29
81% of cases correctly classified
Women
Regulation −.18 .25 < 1 .83 .51–1.36
Availability 1.22 .42 8.49** 3.40 1.49–7.34
Physical (A) −.55 .36 2.31 .58 .28–1.17
Cognitive (A) .65 .31 4.37* 1.92 1.04–3.53
Social (A) 1.07 .40 7.19** 2.93 1.34–6.42
Constant −6.64
90% of cases correctly classified
Israel
Men
Variable
Regulation .15 .28 < 1 1.17 .68–2.02
Availability .88 .45 3.99 2.41 1.0–5.83
Physical (A) −.17 .36 .24 .84 .42–1.69
Cognitive (A) .18 .44 .17 1.20 .51–2.84
Social (A) .96 .43 4.95* 2.61 1.21–6.06
Constant −6.33 1.73
83% of cases correctly classified
Women
Variable
Regulation −.05 .33 < 1 .95 .50–1.88
Availability −.68 .49 1.97 .51 .20–1.31
Physical (A) .24 .41 < 1 1.28 .58–2.82
Cognitive (A) −.88 .46 3.77 .41 .17–1.01
Social (A) 1.13 .50 5.11* 3.09 1.16–8.20
Constant
94% of cases correctly classified
Croatia
Men
Variable
Regulation .39 .16 6.16** 1.47 1.08–1.99
Availability −.33 .35 .90 .72 .36–1.43
Physical (A) .60 .38 2.51 1.83 .87–3.86
Cognitive (A) .19 .27 .52 1.21 .72–2.05
Social (A) .41 .28 2.15 1.50 .87–2.60
Constant −5.54 1.71
75% of cases correctly classified
Women
Variable
Curr Psychol

differences were observed for all three dimensions of accessi-
bility and that this difference was observed for both men and
women. The strongest differences were observed for physical
accessibility (i.e., how easy it was to access gambling oppor-
tunities) with the highest level of accessibility observed in
Croatia (a newly liberalized market) and with lower levels of
accessibility observed in Israel as might be expected based on
its more restrictive gambling legislation. Physical accessibility
was also generally the most strongly endorsed form of acces-
sibility and therefore (by implication) considered to be most
salient accessibility dimension. Similar patterns, but weaker
effects, were observed for cognitive accessibility which was
found to be highest in Croatian respondents for both men and
women, which suggests that students in Croatia were more
confident about how to gamble than those from other coun-
tries. On the other hand, social accessibility (whether people
close to the respondent approved of gambling) was higher in
Australia and Canada (the more established liberalized
markets) and lowest in Israel. In other words, while gambling
wasseenasveryaccessibleinCroatia,peoplewerelesslikely
to approve of it. In Israel, gambling was generally perceived as
less socially acceptable on all three dimensions; it was consid-
ered hard to access, people knew less about how/where to
gamble, and it attracted less social approval.
The results also showed that physical accessibility (despite
being the most endorsed form of accessibility), was not the
principal predictor of gambling risk in the samples. Instead,
the most important factor in Australia, Israel and Croatia was
social accessibility, or whether people had friends and family
members who approved of gambling. These findings are gen-
erally consistent with studies that have highlighted the impor-
tant role of social norms and family influences in the uptake of
gambling and in problem gambling risk (see Dowling et al.,
2017; Lang & Randall, 2013;Thrasheretal.,2011;Zhaietal.,
2017). According to these studies, this occurs because of a
range of factors; social modeling (young people learn how
to gamble and that it is an acceptable activity); common indi-
vidual risk factors (parents who like risk-taking may have
children with similar interests); or socialization (people inter-
act with other people with similar interests). The reduced in-
fluence of physical accessibility might also reflect the fact that
the participants were young adults who increasingly access
gambling online rather than in land-based venues (Hollén
et al., 2020; Sirola et al., 2018). A study conducted in Spain
reported that a mixed-mode gambling access to gambling
(both online gambling and land-based) successfully predicted
at-risk and problem gambling in adolescents (González-Roz
et al., 2017) and that this might also apply to young or emerg-
ing adults as well. Accordingly, future studies could include
more refined measures of the mode of gambling. It may be
that, when gambling is quite accessible and located near to
other frequently visited locations (e.g., shopping centers), peo-
ple no longer have to make special visits in order to gamble as
would be the case with earlier destination venues such as
larger casinos.
Gambling Patterns
The observed country differences in the perception measures
were generally reflected in a similar pattern of differences for
reported gambling participation and scores on the PGSI. This
is important because it serves a form of concurrent or conver-
gent validity for the perceived accessibility findings. In
Canada, Australia and Croatia which have liberal gambling
markets, students reported gambled at higher frequencies,
have more gambling problems, and perceive the market as
more accessible. By contrast, Israelis students were less in-
volved in gambling, had fewer gambling problems and less
physical and social accessibility to gambling. These findings
are not unsurprising, given that EGMs are illegal in Israel.
These findings are generally consistent with the view that
Table 6 (continued)
Australia
Regulation .17 .28 < 1 1.18 .69–2.03
Availability −.26 .65 < 1 < 1 .22–2.78
Physical (A) −.30 .59 < 1 .74 .24–2.36
Cognitive (A) −.66 .44 2.28 .52 .22–1.22
Social (A) 1.44 .50 8.12** 4.21* 1.59–11.30
Constant −3.15
94% of cases correctly classified
Canada
Men
Regulation −.22 .30 < 1 .80 .44–1.46
Availability .74 .59 1.57 2.09 .66–6.60
Physical (A) −.06 .45 < 1 .94 .39–2.25
Cognitive (A) .04 .36 < 1 1.05 .52–2.10
Social (A) .07 .43 < 1 1.07 .46–2.51
Constant −1.77 1.97
71% of cases correctly classified
Women
Regulation −.06 .48 < 1 .94 .37–2.40
Availability .72 .94 < 1 2.05 .33–12.88
Physical (A) −.31 .55 < 1 .73 .25–2.14
Cognitive (A) −.30 .59 < 1 .74 .23–2.35
Social (A) .48 .67 < 1 1.61 .43–6.02
Constant −3.20
93% of cases correctly classified
Regulation = Perception of the quality of regulation of gambling in the
country (higher scores indicate better regulation); Availability =
Perception of how available gambling is in the country (higher scores
indicate that there should be more gambling available, lower = too much
gambling available)
Curr Psychol

limiting the accessibility of certain forms of gambling changes
patterns of gambling participation (although caution needs to
be applied here because of the use of a convenience sample).
Studies in Norway, for example, such as by Lund (2009)
showed that a 2007 law banning EGMs in Norway reduced
gambling among active EGM gamblers and high-risk gam-
blers (Lund, 2009). Similar changes in adolescent gambling
occurred in Spain in response to more restrictive gambling
legislation (González-Roz et al., 2017). In broad terms, these
findings show how greater liberalization of markets appears to
be associated with greater gambling participation and rates of
problem gambling (Kingma, 2004).
At the same time, the results indicate that variations in
exposure to gambling does not appear to affect people the
same way (LaPlante & Shaffer, 2007), as the findings show
in relation to women. Traditionally, gambling venues were
male dominated since not all types of gambling were equally
accessible or culturally acceptable for women (Delfabbro,
2000;Mark&Lesieur,1992). Women were less likely to take
part in gambling activities as female gambling was often as-
sociated with the violation of cultural and traditional gender
roles. However, as gambling has become normalized and so-
cially acceptable women have started to gamble in higher
numbers (Hing & Breen, 2001; Ladd & Petry, 2002). This
normalization and the social legitimacy of this behavior may
be a double edged sword and a risk factor for women. As can
be seen in the findings related to gambling rates, although in
all four countries men had higher rates of gambling and prob-
lem gambling, Australia and Canada were the exceptions in
that women engaged more in weekly gambling (excluding
lotteries). This may be because gambling has become more
normalized in these countries. In Australia, for example,
venues with gaming machines are now gender neutral. They
are located in clean safe venues, with many women working
on staff, game themes are not strongly masculine, and gam-
bling venues are typically offered in multi-functional venues
(e.g., restaurants, event centers, social clubs). People may, in
fact, visit the venues for reasons other than gambling and then
gamble, or gambling may be part of a range of activities un-
dertaken on the same visit (see Thomas et al., 2011).
Similarly, in Croatia, almost every shopping mall has slot-
machine clubs and small casinos, often co-located with cin-
emas. There are also sports betting outlets in neighborhoods
and sports betting can be undertaken at local bars (Ricijaš
et al., 2019).
Methodological Considerations and Implications
The current study has a numberof methodological limitations.
First, this is a cross sectional study and as such cannot make
causal determinations. The study incorporated a convenience
sample, mostly based on a particular segment of the popula-
tion who are more likely to come from higher SES and who
have higher levels of education. This is a potential strength of
the study in that it enabled age and education level to be kept
relatively consistent across the samples, but future cross-
national comparative studies should be conducted on other
segments of population. Second, although the study was able
to control for gender, age and educational differences by sep-
arately analyzing responses by gender and also focusing on
university populations, there are other variables which may be
important. These include differences in the disposable income
or socio-economic status across the countries or religious dif-
ferences. For example, the lower rates of gambling in Israel
may be due to the relatively higher proportion of people with
strong faith (Judaism or Islam). Finally, the current study mea-
sured accessibility through the subjective point of view of the
participants. Thus, future studies should combine objective
measures of accessibility, and also include accessibility to
internet/mobile gambling.
This study highlights the importance of differences in the
regulation and supply of gambling on gambling behavior and
the development of gambling-related harms. Different regula-
tory systems have the potential to influence people’s engage-
ment in gambling, the types of activities engaged in, and the
level of associated harm. The study also highlights the impor-
tance of studying the multidimensional aspects of accessibility
and, in particular, how social legitimacy plays an important
role in the uptake of gambling and how this can impact spe-
cific segments of population. In this study, we showed how
this dimension appears to be particular influential in women’s
gambling behaviors, but such analyses could be extended to
other higher risk populations including adolescent gamblers,
those in developing countries where gambling markets might
be still in the earlier stages of development, or where previ-
ously more restricted markets are opened up through the in-
troduction of more liberalized or free market legislation.
Conclusions
This research yielded a number of insights. First, it showed
that variations in perceptions of the accessibility can be reli-
ably differentiated across countries that are known to differ in
the nature of their gambling markets. In particular, it showed
how both the level of liberalization (as shown in comparisons
between Israel and the other three countries) as well as the
maturity of the market (Croatia as compared with Australia
and Canada) appears to be important in understanding how
people perceive gambling and their level of gambling involve-
ment.
1
Second, the paper confirms Hing and Haw’s(2009)
1
Note that we include measures of religious engagement and identification in
this study which are reported in another paper. The effects for religion were
generally small and do not explain or confound the gender and accessibility
measure effects reported in this paper.
Curr Psychol

emphasis on the multi-dimensional nature of accessibility. In
particular, it shows that physical accessibility (while often the
most endorsed dimension) does not appear as influential as
social factors in determining whether people might be more
likely to develop a stronger or problematic level of gambling
involvement. These findings have important implications for
understanding the role of socialization, the normalization and
cultural acceptance of gambling. Future studies into the gam-
bling accessibility relating to the effects new gambling oppor-
tunities are likely to be limited unless they can capture the
social dimension of accessibility. This appears particularly
important given the growing prevalence of remote or internet
gambling that does not require a physical location.
Author’s Contribution Statements Belle Gavriel-Fried- Was the one of
the principal architects of the project, was in charge of the study design,
and was the principal coordinator of the project. She collected the Israeli
data., and wrote the manuscript.
Paul Delfabbro- Coordinated the Australian leg of the project. He
conducted the statistical analysis, wrote the “Results”section, and drafted
the manuscript.
Neven Ricijas - Was one of the principal architects of the project,
contributed to the development of the survey, and conducted preliminary
analyses. Dora Dodig Hundric - Was one of the principal architects of the
project , compiled the measures, and coordinated the Croatian leg of the
project.
Professor Derevensky- Co-ordinated the Canadian leg of the project,
contributed to the preparation of the manuscript.
All the authors reviewed and approved the final version of the
manuscript.
Data Availability The datasets generated during and/or analysed during
the current study are available from the corresponding author upon rea-
sonable request.
Declarations
Ethical Approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of four institu-
tional review boards of Tel Aviv, Adelaide, Zagreb and McGill
universities.
Conflict of Interest Belle Gavriel-Fried has received a seed grant from
the International Center for Responsible Gamin in 2017 for exploration of
recovery capital in gambling disorder. She has received a grant from the
ministry of science (Israel) for a study about the success of Israeli Arab
students in higher education in Israel in 2017. She has never received
direct gambling industry funding for any research.
Paul Delfabbro has received funding for research, support for con-
ference travel and speaking engagements from government and non-
government research bodies such as AGRI, VRGF, IAGR and the
Department of Consumer Affairs, GambleAware/ RGT, Gambling
Research Australia, Independent Gambling Authority, the ARC,
NHMRC, Channel 7 Children’s Foundation and Australian Institute of
Criminology. He has conducted paid consultancy work on responsible
gambling for regulatory bodies, government, peak bodies such as the
Australasian Gambling Commission and reviews of responsible gam-
bling programs for some industry groups (e.g., reviews of list of indica-
tors, self-exclusion program, host responsibility quality in relation to in-
ternational best practice), but not received direct industry funding for any
research. He acknowledges that many peak research bodies are indirectly
funded by industry through levies or contributions.
Neven Ricijašhas received funds for most of my research from the
University of Zagreb, Faculty of Special Education and Rehabilitation
Sciences, other governmental institutions (e.g. Ministry of Science,
Education and Sport, Ministry of Justice, Croatian Institute of Public
Health), and non-governmental institutions (e.g. UNICEF Office for
Croatia). Some of the research focused on exploring gambling among
different Croatian populations was co-funded and supported by the
Croatian Lottery. He has conducted paid consultative work or training
for the gambling industry (e.g. Croatian Lottery, Croatian Association for
the Games of Chance) in the field of promoting responsible gambling
principles and strategies.
Dora Dodig Hundric has received most of the funding for my re-
search and support for conference travel from University of Zagreb
(Faculty of Education and Rehabilitation Sciences). She has also partic-
ipated in research and projects funded by other governmental institutions
such as relevant ministries, NGOs, Croatian Lottery and Croatian
Association for the Games of Chance.
Dr. Derevensky Jeff holds or has held several recent research grants
from the NCAA, Manitoba Gambling Foundation, Florida Council on
Compulsive Gambling, U.S. National Council on Problem Gambling,
and Social Sciences and Humanities Council in Canada.
He has provided consultations to the Gerald Schwartz and Heather
Reisman International Conference on Child Health, Development and
Welfare, Jerusalem; National Science Foundation (U.S.); By Kids for
Kids; Marsden Fund Council; New Zealand Government; National
Collegiate Athletic Association’s Sports Wagering Task Force; Gamble
Aware, UK; International Olympic Committee, Mental Health Task
Force; The Research Foundation - Flanders (FWO), Belgium; National
Council on Problem Gambling (U.S.); Fonds National de la Recherche,
Luxembourg; International Research Institute for Gambling and Gaming,
Germany; University of Newcastle; Gambling Commission, U.K.;
Government of Hong Kong; Australian Research Council; University
of British Columbia Gambling Research Center; Ontario Ministry of
Health and Long-Term Care; National Association for State and
Provincial Lotteries.
Dr. Derevensky has received honoraria for speaking at conferences
and workshops organized by the University of North Carolina; Morneau
Shepell; Canadian Paediatric Society; New Jersey Council on Problem
Gambling; Champlain College; Montreal Junior Chamber of Commerce;
Massachusetts Council on Problem Gambling; Florida Council on
Compulsive Gambling; Kentucky Council on Problem Gambling.
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