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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information, visit: www.umass.edu/seigma @ImpactsMa