Game over? : adolescent gambling behaviour after interventions in the gambling market : a public health perspective

The Norwegian gambling market grew tremendously in the period from the late 1980s until 2005. The negative consequences of gambling, especially among young people, have received increasing attention in our society. In 2006 and 2007 a natural experiment took place in the Norwegian slot machine market. Banknote acceptors in slot machines were first prohibited in 2006, and all slot machines were removed one year later. Knowledge about how structural changes like this affect behaviour was lacking. The intervention in the slot machine gambling market was a unique opportunity to obtain a better empirical basis for the legitimacy of population-based interventions. The overall aim of this thesis was to assess the empirical basis for the appropriateness of population strategies in curbing problem gambling and furthermore to assess whether the regulations in the Norwegian slot machine market had any impact on gambling and problem gambling among adolescents. This thesis comprises four articles and an overall summary. The data were collected by school surveys carried out in 2002, 2004, 2005, 2006, and 2008. The target population in all the surveys was students from lower and upper secondary schools. A close relationship between the overall amount of gambling and the proportion of problem gamblers in a population was observed, and further, a reduction in the overall amount of gambling among adolescents was accompanied by a collective downward shift in all groups of gamblers, i.e. among excessive gamblers as well as among moderate and light gamblers. After the two interventions in 2006 and 2007, significant decreases were observed in overall gambling. However, the prevalence of problem gambling did not show the same systematic trends. Thus, this discrepancy in trends between problem gambling and gambling behaviour suggests that the observed changes may not only be interpreted as intervention effects, but may also be attributed to other significant changes in the gambling market. The findings represent a clear parallel to the alcohol field, and thus provide empirical support for a total consumption model of gambling behaviour among adolescents. The discrepancies in the consumption of gambling and gambling-related harm points out some important methodological challenges in the assessment of gambling behaviour in a rapidly changing gambling market. The findings of this thesis have several implications. Prevention strategies directed at the total population of gamblers seem highly relevant, as a reduction in overall gambling is related to the level of gambling problems among youths, and thus, policy measures and structural interventions can serve as effective preventive measures