Electronic Gaming Machines and Problem Gambling - Jogo Remoto

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Electronic Gaming Machines and Problem Gambling - Jogo Remoto

This report was prepared by the Responsible Gambling Council (RGC)

research team consisting of:

Monica A. White, PhD

Phil Mun, PhD

Nadine Kauffman, MA

Christina Whelan, MSc

Matthew Regan, MSW

Jon E. Kelly, PhD

We wish to acknowledge Anita Gupta, PhD, for assisting with the preparation

of the report, and Jamie Wiebe, PhD, of Factz Research, for conducting

and analyzing the focus groups and interviews.

The Responsible Gambling Council (RGC) is an independent, non-profit organization

committed to problem gambling prevention. RGC designs and

delivers highly effective awareness programs and promotes the identification

and adoption of best practices in problem gambling prevention through research

and information dissemination.

www.responsiblegambling.org


TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

LITERATURE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

EGM FEATURES 9

Speed of Play 9

Sensory Effects 10

Payment Methods 12

Payout Methods 13

Betting Options 14

EGM-based Inducements 15

Game Availability 16

Programmed Gaming Features 16

EGM-based Responsible Gambling Features (RGFs) 17

VENUE FEATURES 20

Venue Type 20

EGM Accessibility 20

Venue Conveniences 21

Venue Design 23

Advertising 23

Venue-based Harm Minimization Strategies 24

COMMUNITY ACCESSIBILITY FEATURES 25

Number of EGM Venues 26

Proximity of EGM Venues 26

EGM Caps 27

Number of EGMs per Capita (Density) 27

EGMs in Low Income Areas 28

KEY INFORMANT QUESTIONNAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

METHODOLOGY 29

Participants 29

Response Rate 29

Questionnaire 29


TABLE OF CONTENTS

SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING 30

Data Analysis Plan 30

Results 32

SECTION B: MODIFICATIONS TO REDUCE PROBLEM GAMBLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Data Analysis Plan 38

Results 39

FOCUS GROUPS WITH PROBLEM GAMBLERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

METHODOLOGY 61

RESULTS 61

DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

FINDINGS 64

EGM Features 64

Venue Features 65

Community Accessibility Features 65

LIMITATIONS 65

SUMMARY & CONCLUSIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

APPENDIX 1: Key Informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

APPENDIX 2: Key Informant Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

APPENDIX 3: Open-ended Responses to Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

APPENDIX 4: Complete Rankings of Contributors and Modifications . . . . . . . . . . . . . . . . . . . . . . . . . 93

APPENDIX 5: Focus Group Script . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

APPENDIX 6: Counsellor Interviews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

APPENDIX 7: Counsellor Interview Script . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103


LIST OF TABLES

TABLE 1. Questionnaire Response Rates 29

TABLE 2. Most and Least Important EGM Contributors to Problem Gambling (Researchers) 32

TABLE 3. Most and Least Important EGM Contributors to Problem Gambling (Specialists) 33

TABLE 4. EGM Feature Thematic Mean Importance Scores (Researchers and Specialists) 34

TABLE 5. Most and Least Important Venue Contributors to Problem Gambling (Researchers) 35

TABLE 6. Most and Least Important Venue Contributors to Problem Gambling (Specialists) 36

TABLE 7. Venue Feature Thematic Mean Importance Scores (Researchers and Specialists) 37

TABLE 8. Community Accessibility Contributors to Problem Gambling (Researchers) 37

TABLE 9. Community Accessibility Contributors to Problem Gambling (Specialists) 37

TABLE 10. Most Effective EGM Modifications and Perceived Evidence Strength (Researchers) 40

TABLE 11. Least Effective EGM Modifications and Perceived Evidence Strength (Researchers) 41

TABLE 12. Most Effective EGM Modifications and Perceived Evidence Strength (Specialists) 42

TABLE 13. Least Effective EGM Modifications and Perceived Evidence Strength (Specialists) 42

TABLE 14. Most Effective EGM Modifications (Counsellors) 43

TABLE 15. Least Effective EGM Modifications (Counsellors) 44

TABLE 16. Most Effective EGM Modifications (Problem Gamblers) 45

TABLE 17. Least Effective EGM Modifications (Problem Gamblers) 45

TABLE 18. Quartile Ranking (1-4) of Select EGM Modifications by Key Informant Group 46

TABLE 19. EGM Modification Thematic Mean Effectiveness Scores (Total Sample) 47

TABLE 20. Most Effective Venue Modifications and Perceived Evidence Strength (Researchers) 48

TABLE 21. Least Effective Venue Modifications and Perceived Evidence Strength (Researchers) 49

TABLE 22. Most Effective Venue Modifications and Perceived Evidence Strength (Specialists) 50

TABLE 23. Least Effective Venue Modifications and Perceived Evidence Strength (Specialists) 51

TABLE 24. Most Effective Venue Modifications (Counsellors) 52

TABLE 25. Least Effective Venue Modifications (Counsellors) 52

TABLE 26. Most Effective Venue Modifications (Problem Gamblers) 53

TABLE 27. Least Effective Venue Modifications (Problem Gamblers) 53

TABLE 28. Quartile Ranking (1-4) of Most Effective Venue Modifications by Key Informant Group 54

TABLE 29. Quartile Ranking (1-4) of Least Effective Venue Modifications by Key Informant Group 54

TABLE 30. Quartile Ranking (1-4) of Select Venue Modifications by Key Informant Group 55

TABLE 31. Venue Modification Thematic Mean Effectiveness Scores (Total Sample) 56

TABLE 32. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Researchers) 57

TABLE 33. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Specialists) 58

TABLE 34. Community Accessibility Modification Effectiveness (Counsellors) 59

TABLE 35. Community Accessibility Modification Effectiveness (Problem Gamblers) 59

TABLE 36. Item Ranking of Community Accessibility Modifications by Key Informant Group 59

TABLE A1. Rank Order of Mean Importance Scores: EGM Contributors (Researchers and Specialists) 93

TABLE A2. Rank Order of Mean Importance Scores: Venue Contributors (Researchers and Specialists) . . . . . . . . . . . . . . . . . . . . . 94

TABLE A3. Rank Order of Mean Importance Scores: Community Accessibility Contributors (Researchers and Specialists) 94

TABLE A4. Rank Order of Mean Effectiveness Scores: EGM Modifications by Key Informant Group 95

TABLE A5. Rank Order of Mean Effectiveness Scores: Venue Modifications by Key Informant Group 97


Electronic Gaming Machines and Problem Gambling

EXECUTIVE SUMMARY

BACKGROUND

In February 2006, the Saskatchewan Liquor and Gaming

Authority (SLGA), the organization which regulates all video

lottery terminals (VLTs) and slot machines, made a commitment

to review its policies regarding electronic gaming machines

(EGMs) and problem gambling. To inform their review,

SLGA asked the Responsible Gambling Council (RGC)

to conduct a broad-based exploration of Key Informant opinions

regarding best practices in the management of EGMs.

As a non-profit organization whose mandate includes investigation

and dissemination of best practices, RGC not only

agreed to conduct the research on behalf of the SLGA, it also

agreed to contribute financially to the initiative.

The relationship between EGMs and problem gambling is

somewhat ambiguous. There is research to suggest that the

speed of problem gambling onset is faster for EGM players

than for gamblers who engage in other forms of gambling.

This is corroborated by clinical studies that have shown that

EGM gambling tends to be the most common form of gambling

engaged in among individuals seeking treatment for

problem gambling. However, EGMs are among the most accessible

and predominant form of gambling. Thus, it has been

argued that the greater number of EGM players creates the

appearance of a concomitant greater number of EGM problem

gamblers. The RGC analyzed their 2005 prevalence data

on gambling and problem gambling in Ontario and found

that EGM play was the strongest independent predictor of

problem gambling, a finding that is supported by several other

studies. Thus, while there may be inconclusive evidence as

to whether or not EGMs lead to problem gambling, there is

consensus in the literature that EGM use and problem gambling

are strongly related.

Numerous studies have attempted to shed light on the nature

of the relationship between EGMs and problem gambling.

For the purpose of this report, the variables that have

been examined in many of these studies are classified into

three general areas: 1) EGM features, 2) venue features, and

3) community accessibility features. Using these three areas

as its framework, the present study assesses, via the opinion

of various Key Informants, which features are most likely to

contribute to problem gambling, and which modifications to

these features are most likely to reduce EGM-related problem

gambling risk. The report consists of a literature review

of available research on the three framework areas, a survey

of Key Informant opinion, focus groups with EGM problem

gamblers, a discussion of findings and limitations, and, lastly,

a summary and conclusion.

LITERATURE REVIEW

There is a growing body of research that has examined the

structural characteristics of EGMs that may be associated

with problem gambling. These characteristics include the machine’s

speed of play, sensory effects (e.g., lights and sounds),

payment methods (e.g., bill acceptors, direct electronic fund

transfers), payout methods (e.g., tickets, tokens), betting options

(e.g., minimum and maximum bet sizes), EGM-based

inducements (e.g., near-misses, prize advertisements), game

availability (e.g., type and number of games), programmed

gaming features (e.g., win frequency, payout rate), and EGMbased

responsible gambling features (e.g., machine RGFs,

time and money limits).

In addition to the features directly associated with EGMs,

some have hypothesized that the relationship between EGMs

and problem gambling may be partly due to features of the

venues that house the machines. That is, problem gambling

could be associated with the type of venue in which one

gambles (e.g., a hotel versus a casino), one’s access to EGMs

(which is affected by the number of EGMs in the venue, the

hours of operation, etc.), conveniences offered by the venue

(e.g., access to money and/or alcohol), the venue’s design and

advertising campaigns, and the harm minimization strategies

undertaken by the venue to mitigate problem gambling.

Lastly, at the broadest level, a third EGM-related area that has

been identified as being associated with problem gambling is

community accessibility. Features that have been discussed

in the literature that pertain to a community’s overall access

to EGMs include the number of EGM venues, proximity of

EGM venues, EGM caps, number of EGMs per capita, and

EGMs in low income areas.


Electronic Gaming Machines and Problem Gambling

KEY INFORMANT QUESTIONNAIRE

Key Informants from Canada and abroad were invited to

complete a questionnaire on EGM-related problem gambling.

Informants consisted of problem gambling Researchers, identified

through the published literature and/or personal referral;

gaming and problem gambling Specialists (i.e., health

and problem gambling professionals, regulators, operators),

identified through gambling governing bodies and/or

personal referral; problem gambling Counsellors, recruited

through addiction agencies and/or personal referral; and

EGM Problem Gamblers themselves, recruited through problem

gambling services.

The questionnaire was divided into two main sections. Section

A looked at the contributors to problem gambling, and asked

Researchers and Specialists to indicate their thoughts on the

importance of select EGM features, venue features, and overall

community accessibility features as contributors to problem

gambling. Section B looked at modifications and asked

all Key Informants to indicate their opinions on how effective

select modifications to the above features would be in reducing

the risk of problem gambling. Researchers and Specialists

were also asked to indicate their opinion on the strength of

the evidence supporting each modification.

FOCUS GROUPS

Two focus groups with EGM Problem Gamblers were

conducted for this study: one in Regina, Saskatchewan, the

other in Ajax, Ontario. Participants were first asked about

their experiences with gambling and problem gambling.

They were then asked, using the three framework areas as a

guide, what they think it is that contributes to EGM-related

problem gambling, and what they think could be done to

reduce EGM-related problem gambling risk.

DISCUSSION

In reviewing the literature and synthesizing the opinions of a

cross-section of Key Informants for the present study, a number

of findings emerged which identified potential EGM-related

contributors to problem gambling, as well as possible

modifications to reduce problem gambling risk.

EGM Features that Contribute to Problem Gambling

With respect to EGM features, the Researchers and Specialists

regarded fast speed of play, direct electronic fund transfers

(which allow patrons to access bank or credit card funds directly

while sitting at an EGM), the appearance of near-misses,

and bill acceptors as the most important contributors to

problem gambling. The importance of these items was supported

by a thematic analysis which showed that features that

speed up play (e.g., short time intervals between bet and outcome),

involve payment methods (e.g., bill acceptors), and

give the appearance of near-misses were rated much higher

in importance than other EGM features.

EGM Modifications to Reduce Problem Gambling

Consistent with the finding that Key Informants identified

direct electronic fund transfers and bill acceptors at EGMs

as among the most important contributors to problem gambling,

the elimination of these features was ranked among the

modifications most likely to be effective in reducing problem

gambling risk.

Key Informants also endorsed mandatory player registration,

the use of smart cards, the optional or (preferably) mandatory

setting of pre-determined spending limits, and on-screen

running cash totals of the amount spent during an EGM session.

There is little doubt that the Key Informants were very

optimistic about the potential of smart card technology to

address problem gambling. However, this endorsement needs

to be assessed within some limitations of the present study.

Since no definition of “smart card” technology was provided

to Key Informants, it is not possible to know what specific

aspects of the technology they were endorsing. “Smart card”

is to some degree a global term, which can incorporate a variety

of features such as card-based access controls, playercontrolled

self-limits, provider-controlled self-limits, and

self-exclusion.

From a broader perspective, the thematic analysis indicated

that Key Informants believed that modifications aimed at

limiting the amount of money spent and restricting payment

methods were most likely to reduce problem gambling risk.

However, although the Researchers rated speed of play and

the appearance of near-misses as important contributors to

problem gambling, they did not consider reducing the speed

of play or the appearance of near-misses as effective as reducing

the potential for overspending. Overall, Key Informants

were more supportive of modifications to spending and ac-


Electronic Gaming Machines and Problem Gambling

cess to funds, rather than in modifications that might dampen

the emotional experience and excitement of playing on

EGMs.

Venue Features that Contribute to Problem Gambling

According to the Researchers and Specialists in this study, the

most important venue-related contributors to problem gambling

were having ATMs located either on the gaming floor

or close to machines, 24-hour access to EGMs, and marketing

that was targeted directly to the EGM player. Overall, easy

access to money in venues (specifically via ATM machines)

was considered a key contributor to problem gambling.

Venue Modifications to Reduce Problem Gambling

The venue modifications that Key Informants considered to

be most effective in reducing problem gambling risk were

prohibiting access to funds from credit cards at ATMs, disallowing

cheque-cashing at venues, and removing ATMs

from venues. As an alternative to removing ATMs, Key

Informants expressed strong support for introducing other

ATM restrictions, such as imposing tighter controls over

withdrawal limits, a point that is also supported by research

in the literature.

Community Accessibility Features that Contribute to

Problem Gambling

Overall, the Community Accessibility features that Key

Informants believed would be relatively more important

contributors to problem gambling were those related to EGM

distribution; that is, wide dispersion of EGMs throughout

the community, large number of community venues housing

EGMs, and convenient locations of EGM venues (e.g., close

proximity to high residential populations).

Community Accessibility Modifications to Reduce

Problem Gambling

Regarding modifications to community accessibility features,

there was considerable variation among the four Key

Informant groups such that there was no single item that all

groups agreed would be the single most effective modification.

However, the Key Informants as a group agreed that reducing

the number of EGM facilities and centralizing EGMs

to one or a few locations (preferably away from residential

areas) would likely be the most effective community accessibility

modifications.

SUMMARY & CONCLUSIONS

In a broad sense, Key Informants believed that certain features

intrinsic to EGMs, such as the speed of play and appearance

of near-misses, contribute to the risk of problem

gambling. With respect to potential modifications, all Key

Informant groups supported changes that did not directly

involve the functioning of EGMs, but focused instead on the

management of money, pre-commitment, the use of smart

card technology, and restricting community access.

The Management of Money

The management of money emerged as an important issue

related to problem gambling, as many of the highest ranked

items and the thematic analysis focused on the on-screen display

of money, access to money through ATMs, cheque-cashing,

direct electronic fund transfers, and the setting of spending

limits. One of the most consistent opinions to emerge

from this study regarding effective modifications pertained

to limiting a player’s access to funds. Key Informants felt that

restricting direct electronic fund transfers from credit and

debit cards would be beneficial in reducing the risk of problem

gambling.

Pre-commitment

Pre-commitment constitutes the creation of pre-set spending

or time limits that are established prior to the start of a gambling

session. There was considerable support among Key

Informants for the creation of pre-commitment initiatives

for gamblers, specifically for self determined, pre-set limits

concerning the amount of money gamblers could spend in a

given EGM session. It should be noted that Key Informants

also felt that the concept of pre-commitment would be more

effective in practice if it were to be a mandatory requirement

for gamblers rather than optional.

The Use of Smart Card Technology

The mandatory registration and use of smart cards was one of

the study’s most highly endorsed modifications for reducing

problem gambling risk. While the questionnaire did not provide

an extensive opportunity for Key Informants to elaborate

on the type of smart card system that they had in mind, the

Informants appeared to understand that it involved a universal

registration system and a requirement to have a card for

machine access. Given that smart card systems can vary significantly

in nature (e.g., by their time and money spending


Electronic Gaming Machines and Problem Gambling

limits, optional/mandatory features, types and levels of enforcement),

Key Informants would likely have varying views

on the breadth and comprehensiveness of such systems.

Restricting Community Access

In terms of community accessibility, although there was

relatively strong support for all the modifications examined,

the study seemed to suggest that the Key informants overall

preferred restrictions on the number of EGM venues and

the centralization of machines within a community as the

most effective modifications for reducing the risk of problem

gambling.

Other Notable Observations

Among the Key Informants, Researchers and Specialists were

asked to assess the strength of evidence for each EGM, venue,

and community accessibility modification item. Overall,

there were low levels of confidence in the strength of the current

evidence base. There was also little connection between

the Key Informants’ perception of evidence strength, and the

strength of the evidence found in the literature.

The literature reviewed for this study demonstrated that the

current knowledge base regarding ways to reduce EGM-related

problem gambling is limited and incomplete. Most working

in the field agree that a strong relationship exists between

problem gambling and EGMs. Less clear is the question of

how best to address this relationship. While research on the

mechanics of EGMs provides insight into machine dynamics

and player behaviour, such research offers less guidance as

to what can be done to reduce problem gambling risk. This

study gathers the opinions of some of those who have helped

define the field and knowledge base in order to provide information

that will be of assistance to policy-makers responding

to the dilemmas posed by EGMs. In order for the findings

of this study to be useful, however, they must be interpreted

within a given jurisdiction’s socio-political, geographic, and

economic context.

Implications and Future Directions


Electronic Gaming Machines and Problem Gambling

INTRODUCTION

In February 2006, the Saskatchewan Liquor and Gaming

Authority (SLGA), the organization which regulates all video

lottery terminals (VLTs) and slot machines, made a commitment

to review its policies regarding electronic gaming machines

(EGMs) and problem gambling. To inform their review,

SLGA asked the Responsible Gambling Council (RGC)

to conduct a broad based exploration of Key Informant

opinion about best practices in the management of EGMs. ii

As a non-profit organization whose mandate includes investigation

and dissemination of best practices, RGC not only

agreed to conduct the research on behalf of the SLGA, it also

contributed financially to the initiative.

BACKGROUND

Controversy and debate have surrounded EGMs for the last

14 years. 4,5 The genesis of the controversy stems from Dr.

Robert Hunter, a psychologist at Las Vegas’ Charter Hospital,

who claimed that players of EGMs (particularly video poker)

EGMs such as VLTs and slot machines are technologically complex, but

simple to use machines characterized by fast speed of play, bright colours,

music, flashing lights, and random payout schedules. Whereas slot machines

used to pay out in the form of cash, they now, similar to VLTs, may

pay out in the form of tickets or tokens. 1 While in the past slot machines

operated mechanically, today both slot and VLT machines have electronic

operations. The only real difference remaining between the two types

of machines seems to be the wider dispersal of VLTs in the community

compared to slots, which are typically associated with casinos. Given their

similarity and the fact that there does not appear to be any substantive

research that differentiates between the two types of machines in terms

of problem gambling outcomes, 2,3 no distinction was made between VLT

and slot machines in the present report. Moreover, it is expected that the

definition of what constitutes an EGM will be expanded in the future as

machines grow together.

“bottomed out” more quickly than those who played more

traditional games. 4 This assertion was supported empirically

by two studies which found that, among problem gamblers,

the speed of problem gambling onset was faster for EGM

players compared to players of other forms of gambling

(such as cards, dice, horses, dogs, bingo and scratch cards).

The authors of these studies speculated that the association

between EGMs and problem gambling was due to the “rapid,

continuous and repetitive nature of EGMs”. 6,7 Clinical studies

also show that among problem gamblers seeking treatment,

use of EGMs tend to be the most common form of gambling

engaged in. 8-14

However, EGMs are also among the most accessible and

predominant form of gambling. 15 In Canada, there are over

80,000 machines available across the country, generating by

far the greatest revenue over all other forms of gambling. 16

Thus, it has been argued that the greater number of EGM

players in the population makes it seem that there is a concomitant

greater number of EGM problem gamblers. However,

it may be that there are proportionally fewer EGM problem

gamblers compared to problem gamblers who engage in other

forms of gambling. 17 The RGC analyzed their 2005 prevalence

data on gambling and problem gambling in Ontario

and found that EGM play was the strongest independent predictor

of problem gambling, even after controlling for gender,

education, and other forms of gambling. 2 Similarly, results of

an epidemiological study from Prince Edward Island found

that among gambling activities VLT play had the strongest

unique relationship to problem gambling. 18 EGM play, in

comparison to other forms of gambling, was also found to

be most highly related to problem gambling in Brazil, with

EGM players not only displaying the greatest commitment to

gambling, but also the most distress. 19

Thus, even though there is equivocation in the empirical evidence

as to whether EGMs lead to problem gambling, there is

consensus in the literature that EGM use and problem gambling

are strongly related. Numerous studies have attempted

to shed light on the nature of the relationship between EGMs

and problem gambling. For the purpose of this report, the

ii It is important to note at the outset of this report that the causes of

problem gambling are complex. They involve a set of interactions between

individual players, the game they are playing, and the environment they

are playing in. Ultimately, the beliefs, attitudes, and behaviours of the individual

player are the primary determinants of trouble-free gambling.

However, the providers of gambling, like the providers of any product,

have a responsibility to take action to limit any potential abuse or harm

that may be related to the use of their product. The present report focuses

exclusively on the informed opinion of best practices for the provision

of EGM gambling, rather than on the best practices for the individual

gambler.


Electronic Gaming Machines and Problem Gambling

variables that have been examined in many of these studies

may be classified into three general areas: 1) EGM features,

2) venue features, and 3) community accessibility features. 1,

20-23

Using these three areas as a framework, the present study

seeks to determine which features are seen as most likely

to contribute to problem gambling, and which modifications

to these features may reduce EGM-related problems.

Towards that end, the study reviews the available literature

in the three areas and gathers the opinions of a cross-section

of Key Informants; specifically, gambling and problem gambling

Researchers, Specialists (i.e., health and problem gambling

professionals, regulators, operators), problem gambling

Counsellors, and EGM Problem Gamblers themselves. The

report consists of the following sections:

• A literature review of the three EGM framework

areas taken from academic research,

governmental reports, and policy documents

at both the national and international level

(Chapter 1);

• A description of the questionnaire that was administered

to Key Informants along with the

questionnaire’s findings (Chapter 2);

• The method and results of the focus groups

that were conducted with Problem Gamblers

(Chapter 3);

• A discussion of the study’s main findings and

limitations (Chapter 4); and finally,

• A summary and conclusion (Chapter 5).

To ensure the quality, objectivity and integrity of the research,

the present study was reviewed by an expert panel consisting

of Dr. Harold Wynne (Wynne Resources Limited, Alberta),

Dr. Nigel Turner (Centre for Addiction and Mental Health,

Ontario), and Mr. Michael O’Neil (South Australian Centre

for Economic Studies, South Australia). RGC assumes full

responsibility for the final content and conclusions of the

report.


Electronic Gaming Machines and Problem Gambling

1 LITERATURE REVIEW

EGM FEATURES

In the literature, there is a growing body of research that has

looked at the structural characteristics of EGMs that may be

associated with problem gambling. iii Structural characteristics

refer to features such as an EGM’s speed of play, sensory

effects, payment methods, payout methods, betting options,

EGM-based inducements, game availability, programmed

gaming features, and EGM-based responsible gambling features

(RGFs). The research literature found on each of these

features is discussed in turn below.

Speed of Play

Speed of play on an EGM refers to the time interval between

successive plays on a machine. The shorter the time interval,

the more frequently events (bets) can occur. EGMs are characterized

as having an event every few seconds. This differs

significantly from the lottery, for example, that occurs once

or twice per week. It has been suggested that the faster the

event frequency, the more likely it is that a gambling activity

will lead to problems. 21 EGM speed can be broken down into

two sub-features: reel spin speed and stop buttons. They are

each discussed in turn.

Reel Spin Speed

Definition. Reel spin speed, measured in seconds, is the

length of time elapsed for a slot machine’s reels to complete a

round of spinning. It reflects the time between the onset of a

bet and its final outcome on a single round of play.

iii A number of terms have been used in the literature to describe problem

gambling. Aside from the term problem gambling itself, some of these

terms include compulsive gambling, pathological gambling, probable pathological

gambling, and disordered gambling. For the sake of simplicity, the

term problem gambling will be used throughout this report.

Association with problem gambling. Several studies in the

literature have explored how reel spin speed affects gambling.

One study conducted in Australian hotels and clubs

with problem gamblers and non-problem gamblers examined

the impact that certain EGM modifications, including

reduced speed of play, had on player satisfaction, enjoyment,

behaviour, and expenditure. Results revealed that both the

non-problem and problem gamblers rated lower levels of enjoyment

and satisfaction with the slower 5-second reel spin

speed (lowered from 3.5 seconds). Rapid speed of play (i.e.,

3.5 seconds) was not found to have any positive or negative

impact on any of the parameters of play (i.e., time spent playing,

number of bets, net loss), nor was it found to be related

to problem gambling status, the severity of problems, or the

amount of money spent. Notwithstanding these findings, it

is not possible to tell from this study whether reductions in

speed of play would be differentially effective for problem

gamblers as compared to non-problem gamblers, as there

were insufficient numbers of problem gamblers in the research.

24, 25

A second study examining manipulation of speed of play

was conducted in a laboratory setting with non-problem

and problem VLT gamblers. This study sought to determine

participants’ self-reported reactions to the combined manipulations

of speed and sound under three conditions: 1) decreased

speed/no sound, 2) standard speed/standard sound

(control condition), and 3) increased speed/standard sound.

Results revealed that a reduction in the speed of play and the

removal of sound altogether decreased ratings of enjoyment,

excitement, and tension-reduction in the problem gamblers

as compared to the non-problem gamblers. However, the lab

setting, the small sample size, the reliance on self-report, and

the confounding iv of sound and speed of play in the study

limit the conclusions that can be drawn from the research. 22

Finally, in our review of the literature, another laboratory

study was found which investigated the effects of VLT speed

of play among a community sample (N = 43). The particular

purpose of the study was to see if variations in speed of play

had an impact on player concentration, motivation to play,

loss of control, and number of games played. Participants

were randomly assigned to play either a high-speed (5-seciv

In research, confounding occurs when variables of interest are not

properly controlled for. This results in the researcher being unable to determine

the impact of any one variable on the observed result, thereby

limiting their ability to draw conclusions about cause and effect.


Electronic Gaming Machines and Problem Gambling

ond) machine (the typical speed that VLTs are played in the

community where the study took place) or a low-speed (15-

second) machine. Results revealed that gamblers who played

the high-speed machine, as compared to those who played the

low-speed machine, played more games and underestimated

the number of games played. However, speed of play did not

seem to have an impact on player concentration, motivation,

or loss of control over time or money spent. The authors of

the study concluded that speed of play does not seem to have

an impact on occasional VLT gamblers, and that speed restrictions

are not an important harm minimization strategy. 26

However, it should be recognized that there are some significant

limitations to the study’s generalizability. First, the study

was conducted in a laboratory setting and thus may not apply

to actual gambling venues. Second, given the absence of

problem gamblers in the study, the findings cannot be used to

predict what impact speed of play may have on actual problem

gamblers’ behaviour.

Stop Buttons

Definition. Stop buttons are a feature found on many types

of EGMs that allow gamblers to terminate the spinning of

the machines’ reels rather than wait until they have run their

full course. By controlling how long the reels spin, the gambler

is in a sense controlling the machine’s speed of play. For

instance, if the “natural” spinning duration of the reels is five

seconds but the gambler presses the stop button after two,

the game will end three seconds earlier than it would have

otherwise. While this may not have much of an impact on

speed of play after a single bet is made, it could have a significant

impact if the stop button is pressed consistently after two

seconds over many sequential bets. Eventually, more games

would be played within the same unit of time than would be

played had the reels stopped on their own.

Association with problem gambling. While a stop button allows

players to influence to some extent their length of playing

time, some players may mistakenly believe that, through

the stop button, they may influence their chances of winning.

A study looking at the effect of the stop feature among occasional,

non-problem, VLT gamblers demonstrated that players

developed the illusion that their chances of winning were

improved when the stop feature was used. Specifically, 87%

believed that stopping the reels would bring different symbols

on the screen, 57% believed that they could control a game’s

outcome, and 26% believed that they could enhance their

probability of winning when using the device. Conversely,

those who played on a machine without a stop feature did

not develop the illusion of control to the same extent. They

also played significantly fewer games. 27 Since this study only

focused on occasional, non-problem gamblers, however, the

observed effects cannot be generalized to problem gamblers.

A second laboratory study, though, did explore the effect of

stopping the reels on VLT play with both problem and nonproblem

VLT gamblers. Results revealed that irrespective of

gambling status, players were bothered when they could not

stop the reels and were more likely to choose to play a game

in which they could. 22

There is also research from Nova Scotia that has looked at the

effects of disabling the stop button feature as well as reducing

speed of play. (It also examined two other modifications

implemented in two separate phases: reduced VLT hours of

operation and the removal of VLTs altogether from certain

venues). Random sample surveys were conducted with the

general adult population (N = 403) and VLT players specifically

(N = 865) at each phase of the study to ascertain the effect

of these initiatives. The authors of the study reported that

disabling the stop button and reducing speed of play resulted

in a reduction of spending for 14% of the total VLT player

base, with problem gamblers decreasing their spending by

an average of $219 per week. VLT players also reduced their

playing time on the machines by an average of 211 minutes

per week, with problem gamblers reducing their time spent

playing by an average of 376 minutes per week. The study

also found that 8% of VLT players shifted gambling activities

as a result of the disabled stop button/reduced speed of play

initiative, and that 40% were in favour of the stop button removal/reduced

speed of play initiative. 28 It should be noted,

however, that because modifications were implemented at the

same time in this study, it is difficult to know which one, or

whether their combination, lead to the observed outcomes.

Sensory Effects

Sound Effects

Definition. Sound effects are programmed noises that EGMs

make. They can include narration, background music, musical

tunes after a win, and “realistic” noises such as the sound

20, 29

of coins falling into a tray.

Association with problem gambling. It has been suggested in

the literature that certain features of music may be associ-

10


Electronic Gaming Machines and Problem Gambling

ated with gambling behaviour. For example, the quality of the

music that an EGM plays may be closely tied to the quality of

the machine, which may be the primary reason why a gambler

might select it to play on. The familiarity of the music

may represent something special to the gambler, which may

influence perseverance in the face of game complexity. The

distinctiveness of the music may make the game more memorable

to the player, which may facilitate further gambling.

Finally, the sounds associated with winning might create the

illusion that winning is more common than losing, since losing

is not identified by

30, 31

music.

A number of studies found in our review looked at the relationship

between machine sound effects and problem gambling.

In the first study, participants (N = 382) ranked 13

structural characteristics (e.g., sound, graphics, background/

setting, game duration, rate of play, etc.) for their importance

to video game enjoyment. Results showed that almost twothirds

of the sample said that realistic sound effects were the

most important feature related to game enjoyment. For the

purposes of this report, however, there are two noteworthy

limitations to this study. First, it focused solely on video

games, which are not an exact proxy for EGMs. Second, it did

not report findings from problem, or even high frequency,

players. That said, the authors of the study argued that the

structural features of EGMs and video games are essentially

the same, especially since many EGMs now use video game

technology. The authors recognized, however, that the consequences

of high frequency gambling are certainly greater than

the consequences of high frequency video game playing. 29

The second study found in our review focused on adolescent

gamblers. In this study, respondents (N = 50) were surveyed

to find out which slot machine features were most attractive

to them. Findings indicated that 30% of respondents felt

that the aura of slot machines (their music, lights and noise)

was one of their most attractive features. Furthermore, those

identified as problem gamblers in the study reported feeling

significantly more attracted to the aura of the machines than

non-problem gamblers 32 . A limitation of this study, however,

is that the independent effect of each structural characteristic

was not assessed.

Another empirical study examined the effects of sound on

persistence of EGM play. The researchers tested the length

of time that participants spent playing an EGM simulator

when sound effects made it appear that other gamblers were

winning in the next room. Results revealed that those who

heard the sound effects and perceived that other players were

winning gambled for longer periods of time and spent more

money doing so. These findings suggest that sounds do in

fact influence, or encourage, extended and/or continuous

play among EGM players. No mention was made in this

study, however, of whether the impact of sound effects would

be more pronounced for problem gamblers as compared to

non-problem gamblers. 33

In terms of the impact that modifying EGM sound effects

might have on problem gambling, the laboratory study reviewed

earlier, which looked at reaction to speed and sound

modifications with problem and non-problem VLT gamblers,

is relevant. 22 Results of that study showed that a reduction in

speed of play and the removal of sound altogether decreased

ratings of enjoyment, excitement, and tension-reduction in

problem gamblers as compared to non-problem gamblers.

Note again, however, that speed of play and sound were confounded

in this study, so one cannot know if the findings are

due to one factor over the other or a combination of the two.

No other studies exploring the independent effects of reducing

sound volume or removing sound altogether from EGMs

were found.

Visual Effects

Definition. Visual effects on EGMs can include flashing lights,

5, 20

primary colours, furnishings and iconology.

Association with problem gambling. The literature on visual

effects is quite limited and has not changed much in the last

13 years.31 One empirical study looking at the effect of coloured

lighting on gambling behaviour found that non-problem

gamblers placed more bets and lost more money when

they were exposed to red, as compared to blue, lighting (presumably

because red lighting is more arousing). 34 However,

there was no inference as to whether this finding would be

observed among problem gamblers as well. Interestingly, it

has been noted that gambling venues in the USA and UK are

often decorated with colours that tend toward the red end

of the colour spectrum (i.e., black, red, purple). 31, 34 It has

also been suggested that primary colours and flashing lights

contribute to the air of fun and excitement of playing on an

EGM. 34,35

In addition to the above observations, one other study can

be mentioned here. It is the aforementioned questionnaire

study of adolescent gamblers which found that 30% of the

11


Electronic Gaming Machines and Problem Gambling

sample claimed that the aura of slot machines (their music,

lights and noise) was one of their most attractive features.

Moreover, those identified as problem gamblers in the study

reported being significantly more attracted to the aura of

EGMs as compared to non-problem gamblers. 32 Recall, however,

the limitations of this study: Due to the fact that the

separate structural features of EGMs (e.g., their music, lights,

and noise) were not investigated separately, it is difficult to

determine which one was most attractive to respondents.

Payment Methods

Bill Acceptors

Definition. Many EGMs are equipped with bill acceptors

which allow dollar bills to initiate play, in addition to coins

or tokens.

Association with problem gambling. Bill acceptors on EGMs

are convenient because they do not require gamblers to continually

insert coins or tokens into the machines, or to have

the exact amount of change or tokens to play. However, the

insertion of a bill into a machine converts the full monetary

value of that bill into game credits, thereby enabling faster,

more continuous play. Indeed, one study was found in our

review showing that coinless machines can speed up playing

time by 15%, due to fewer breaks being taken to obtain

proper change and less downtime being spent refilling coin

hoppers. 36 The risk of problem gambling potentially increases

with larger denomination bill acceptors because they effectively

allow larger amounts of money to be converted into

credits at one time.

While not specifically referring to problem gambling, the link

between gambling expenditures and bill acceptors has been

noted by policy analyst, Michael O’Neil. He observed a positive

relationship between the two variables in two Australian

states: Victoria, where bill acceptors are allowed, and South

Australia, where they are not. While recognizing that there

are many factors involved in determining EGM gambling

losses, O’Neil reported that there was a significant difference

between the two Australian states in this regard: In Victoria,

net EGM gambling losses were over $A90,000 per machine,

while in South Australia, they were over $A50,000. 37

Research on bill acceptors seems to be focused only on the relationship

between denomination size and expenditure. No research was found

in our review that explored limitations to preloading bill acceptors (e.g.,

inserting multiple bills at one time).

The direct link between problem gambling and bill acceptors

was identified in a different Australian study which showed

that over 65% of problem gamblers “often or always” used

bill acceptors, as opposed to 23% of non-problem gamblers.

The authors of the study stated that the bill acceptors

decrease the need for breaks, and thus the opportunity to

reflect on gambling activity. 38 Similarly, a community survey

(N = 755) found a strong relationship between being a

regular or self-identified problem gambler and frequent use

of EGM bill acceptors: compared to recreational gamblers,

the majority of regular and problem gamblers always used

bill acceptors. They also tended to use bill acceptors of larger

denominations. 39

A study exploring the impact of limiting EGM bill acceptors

to $20 was conducted in Queensland, Australia. Two methods

of data collection were used. The first involved interviews

with study participants (N = 359); the second involved an

analysis of EGM revenues generated during the experimental

period. Results revealed that 61% of those interviewed approved

of the $20 limit, 28% believed that the limit should

be reduced further, and approximately 20% reported changes

in their behaviour, especially if they were at high risk for

problem gambling (30-40% of high-risk problem gamblers

reported a change in behaviour). Specifically, those who said

they changed their behaviour reported spending less time

and money gambling, reducing their bet size, and visiting

the gaming venue less frequently. Interestingly, however, the

concomitant revenue analysis indicated that implementation

of bill acceptors did not lead to a significant loss of EGM

earnings. The authors of this study recognized that the two

sets of results were counterfactual, and suggested that either

there was a discrepancy between participants’ reported and

actual behaviour, or that estimates suggesting that problem

gambling contributes significantly to gambling revenues are

inflated. 40

A second study was found looking at the impact of modifying

EGMs in a number of ways, including limiting bill acceptors

to a maximum of $20. The study sample included recreational

and problem gamblers frequenting clubs and hotels.

The results revealed that while limited denomination bill acceptors

(i.e., $20) reduced overall machine expenditure, recreational

and problem gamblers did not differ in their rates of

expenditure reduction. Moreover, though problem gamblers

seemed to prefer using machines with higher denomination

bill acceptors, the authors of the study concluded that the use

12


Electronic Gaming Machines and Problem Gambling

of high denomination bill acceptors was not independently

associated with problem gambling status, severity of problem

gambling, amount of money lost, or persistence of play when

taking into account other factors such as age, gender, credits

wagered per bet, and play rate. This conclusion was consistent

with anecdotal reports obtained from problem gamblers

in focus groups who indicated that limiting the denomination

of bill acceptors would be unlikely to lead to changes in

24, 25

their patterns of play.

A final study comes from Nova Scotia, which has 15 years of

experience with bill acceptor equipped VLTs. An evaluation

of patrons’ opinions about bill acceptors and VLTs found that

non-problem and problem gamblers viewed bill acceptors as

an effective method to assist with the management of time

and money spent on EGMs, especially for players who set

budgets for play. 41

Direct Electronic Fund Transfers

Definition. Direct electronic fund transfers allow patrons to

access bank or credit card funds directly while sitting at an

EGM. This capability makes accessing funds far more convenient

than the alternative, which is to step away from the

EGM to obtain money from some other source (e.g., a nearby

ATM).

Association with problem gambling. When New Jersey regulators

in 1996 agreed to let casino patrons use credit and

debit cards to purchase gambling chips and slot tokens, problem

gambling experts sounded alarm bells, stating that such

technology would wreak havoc with some problem gamblers.

They also argued that it would make even casual gamblers

lose more than they had originally planned. 42 However, no

empirical research was found in our review that explored

the actual implications of placing direct debit technologies

at EGMs. As well, no empirical research was found exploring

the effectiveness of eliminating direct electronic fund

transfers from machines. The apparent absence of this type

of research may be due to the fact that direct electronic fund

transfer technology is new and not yet widely practiced.

Credit Displays/Credit Conversions

Definition. Credit displays/credit conversions are not actually

methods of payment; rather, they refer to what happens

to payment immediately after it is inserted into an EGM.

Because they are tied to payment, however, they are included

in the Payment Methods section of our review.

When money is inserted into an EGM, it is usually converted

automatically into credits that are displayed on the machine

and used to gamble. For example, if $5 were entered into a

machine that operated with 2 cent credits, there would be

a total of 250 credits displayed and made available. The display

of money wagered in the form of credits is also called

tokenization. 24

Association with problem gambling. While the ability to insert

money into a machine to obtain credits may be a convenient

feature (i.e., it saves the gambler from having to exchange

money for tokens), it has been hypothesized that this

could contribute to faster speed of play, since the gambler

essentially has a running credit on the machine. It has also

been hypothesized that a credit display instead of cash can

contribute to misjudgements about how much money one is

actually spending and, ultimately, increase the risk of problem

gambling. 20 Aside from converting money into credit,

EGMs can also convert wins into additional game credits, a

feature which could further prolong play and, again, increase

the risk that problems will occur. 1

While our literature review did not find any empirical evidence

to support the above hypotheses, four related studies

were found. The first two, conducted in the 1960s, found

that gamblers tended to make more cautious decisions

about wagers when they gambled with real money as opposed

to credits. The implication of these studies is that an

action, such as tokenization, which conceals the true value

of money may also contribute to reduced caution in wagering

decisions. 43,44 The third study found in our review showed

that after tokenization was introduced in New South Wales,

Australia, the largest annual increase in EGM expenditure

was observed. 23 Finally, a study of players awareness of, and

attitudes towards, modifications to VLTs found that players

rated displaying cash totals instead of credits to be a highly

effective modification for assisting them in keeping track of

how much money they were spending. No differences were

observed in this study, however, between non-problem and

problem gamblers. 41

Payout Methods

Tickets or Tokens

Definition. The means of receiving one’s payout or winnings

from an EGM is entirely dependent on the design of the

machine. Some machines (e.g., those with Ticket-In Ticket-

13


Electronic Gaming Machines and Problem Gambling

Out (TITO) technology) deliver the payout or winnings in

the form of a ticket that must be redeemed by a cashier or

machine. This technology is rapidly becoming the industry

norm. Payouts can also be delivered in the form of tokens

that must be redeemed by a cashier. The difference between

ticket and token payout methods is that the latter may be

seen as more cash-like since tokens are physically similar to

coins.

Association with problem gambling. It has been hypothesized

in the literature that payouts in the form of tickets or tokens

instead of cash can distort player perceptions of win size. 20

No evidence could be found in our review, however, to support

this hypothesis. Similarly, no research could be found

that addresses the potential impact that modifications to payout

methods could have on problem gambling.

Cheques

Definition. The payout interval on an EGM refers to the delay

in time between when a player wins a game and when they

receive their winnings. One method of extending the payout

interval is to deliver the player’s winnings (when the winnings

are relatively large) by cheque. If winnings are paid out

to the gambler this way, they cannot be cashed in for more

tokens or credits at the gaming venue, which is believed to be

a helpful tool in minimizing harm.

Association with problem gambling. Two studies were found

that investigated the effect of cheque payments on the behaviour

of EGM players. The first study involved interviews with

self-identified problem gamblers (N = 16), recreational gamblers

(N = 45), gaming managers (N = 60), community representatives,

counsellors, and expert analysts. It looked at the

impact of paying patrons with a cheque for winnings greater

than $1,000. While 55% of club managers, 66% of recreational

gamblers, and 72% of problem gamblers all affirmed that

the effort was an effective strategy to prevent gamblers from

spending their winnings, all groups claimed that many, if not

all, gamblers would play down their winnings on machines

or would cash out their winnings before reaching $1,000 to

avoid receiving a cheque. 46

The second study looked at EGM players’ (N = 418) attitudes,

awareness, beliefs, perceptions, challenges and behaviours related

to a number of harm minimization strategies, including

payment of winnings by cheque. Results revealed that 77% of

EGM players thought that payment by cheque for winnings

in excess of $2,000 would be an effective harm minimization

strategy. Problem gamblers, however, were more likely

than all others in the sample (25% versus 16%, respectively)

to say that cheque payment would not be an effective harm

minimization measure. Seventy-two percent of the sample

thought that placing restrictions on cashing winning cheques

at gaming venues would be an effective harm minimization

strategy. 45

Betting Options

Bet Size (Amount/Lines)

Definition. Bet size is determined by a number of factors, including

the denomination of the machines (the value of each

credit), the number of lines one can bet on, and the number

of credits played. For example, a small bet size can result

from betting on one line for one credit (each credit valued

at 5 cents) for a maximum bet size of 5 cents. Conversely, a

large bet size can result from betting on 10 lines for 10 credits

(each credit valued at 10 cents) for a maximum bet size of $1.

(Note, however, that in the latter example, a gambler does

not need to bet the maximum possible amount. He or she

could bet on all 10 lines but choose to use fewer credits (i.e.,

10 credits each valued at 5 cents, which would amount to a

50 cent bet)). In general, the higher the bet, the higher the

payout when one is presented with a winning combination

of symbols.

Association with problem gambling. A self-report study

conducted in the laboratory with problem and recreational

gamblers demonstrated that problem gamblers tend to use

the maximum credit function and that recreational gamblers

do not. Cited in 22 Other studies have shown that compared to

non-problem gamblers, problem gamblers are more likely to

place bets over $1, and that when the maximum possible bet

size is reduced, so is both gambling (i.e., duration, frequency,

expenditure, losses), and other behaviours often associated

with it (e.g., smoking and alcohol consumption). 22,23

A study conducted in Australian hotels and clubs with problem

gamblers and non-problem gamblers examined the impact

of certain machine modifications, including allowing

for a $10 versus $1 bet size option, on player satisfaction and

enjoyment, behaviour, and expenditure. While only a small

percentage of the sample reported wagering with bets greater

than $1, problem gamblers were three times more likely

than recreational gamblers to wager with the larger amount.

14


Electronic Gaming Machines and Problem Gambling

Moreover, the modified machines allowing for $1 bets as

compared to $10 bets were associated with players gambling

for shorter periods, making fewer bets, losing less money, and

smoking/drinking less. The authors of the study concluded

that the reduction in maximum EGM bet size from $10 to $1

might be an effective harm minimization strategy for a small

23, 24

proportion of players.

EGM-based Inducements

Near-misses

Definition. A near-miss on an EGM occurs when one appears

to come close to, but does not actually succeed at, winning

a prize. For example, in the case of a three-reel slot machine

where a winning jackpot is represented by three cherry

symbols, a near-miss would occur if the player received two

cherries and a star. However, in reality, a near-miss is always

a complete miss because it has no reward.

Association with problem gambling. A potential problem

with near-misses is that they could give the gambler a false

sense that a win is imminent and, as a result, prompt further

play. 47,48 This possibility was explored in a study conducted

with a sample of non-problem gambling university students

( N = 72). In this study, the experimental group was exposed

to 27% near-misses, while a second, control group, was exposed

to none at all. Results revealed that those exposed to the

near-misses played 33% more games than the control group.

While this study was conducted with a sample of university

students as opposed to problem gamblers, it does suggest

that, in general, the perception of near-misses may be linked

to gambling persistence in the face of monetary loss. 49

A second study, using an unspecified sample, examined

three rates of near-miss presentation--0%, 33% and 67%--on

gambling persistence using a computerized roulette game. A

near-miss was operationally defined as an outcome with fewer

than three numbers away from the number that had been

chosen for the wager. Results revealed that half of the participants

in the 33% condition made additional bets during

the free-choice period, while none of the participants in the

other conditions did. 47, 50 One interpretation of this finding is

that too many near-misses decrease a player’s expectation of

a win, but when near-misses are intermittent, the player continues

to believe that subsequent wins are likely. 51 Given that

the authors of this study did not describe the problem gambling

status of their sample, however, it is impossible to know

whether the impact of near-misses on gambling persistence

would be more or less relevant for problem gamblers.

A third study, conducted with a sample of undergraduate students

(N = 180) in the laboratory, examined three rates of

near-miss presentation--15%, 30% and 45%--on EGM gambling

persistence. Persistence was defined as the number of

trials played after the near-miss condition was presented over

the course of 50 plays. Results revealed that the 30% nearmiss

condition led to greater persistence than did the 15% or

45% conditions. As in the previous study, the authors of this

study concluded that when there are too many near-misses,

participants no longer view them as indicators that a win is

close at hand. 48 However, similar to the previous study, we

do not know from this research whether near-misses differentially

affect problem gamblers. It should also be noted

that the rates of near-miss presentation used in this study do

not reflect real-life gambling settings, where a near-miss may

occur only 3% to 20% of the time, depending on the prize

size that the symbols represent. (For example, a near-miss

representing large prizes will occur far less frequently than

near-misses representing smaller prizes). Due to this inconsistency,

the external validity of this study is limited.

Reel Display

Definition. Some EGMs are programmed to prolong the presentation

of a bet’s final outcome and thereby increase anticipation.

For example, in the case of a three-reel slot machine,

each reel will stop spinning at different times so that the first

reel stops spinning first, the second stops next, and the third

stops last.

Association with problem gambling. A study with university

students (N = 28) who were occasional VLT players and not

considered to be problem gamblers explored the effects of instantaneous

versus sequential symbol presentation (i.e., each

symbol stops individually) of bet outcomes. Results indicated

that sequential presentation encouraged prolonged play, a

finding theorized to result from the generation of sustained

winning expectancy or anticipation. 52 No other research on

this topic was found in our literature review.

Prize Advertisements

Definition. There are two forms of prize advertisements on

EGMs. The first involves obvious prize advertisements placed

on the EGM itself, such as signage indicating the size and

method of a win. The second involves prize symbols placed

15


Electronic Gaming Machines and Problem Gambling

on the EGM’s reels, which are viewed by the player as the

reels spin during play.

Association with problem gambling. No research was found

on the relationship between EGM prize advertisements and

problem gambling in our review.

Game Availability

Type of Games

Definition. The type of game available on an EGM can vary

from line games (e.g., slot-like games), to card games (e.g.,

poker), to keno (e.g., lottery).

Association with problem gambling. No evidence was found

in the literature indicating that the availability of any one

type of game on an EGM is more or less problematic than

another.

Number of Games

Definition. Some EGMs are equipped with multiple games,

allowing the player more options and potentially increasing

their duration of play on a given machine.

Association with problem gambling. It is possible that switching

between games on an EGM could increase the amount of

time spent on that machine. A machine that has a number of

different games may also appeal to more people, thereby potentially

increasing machine traffic. 53 No research was found

in our literature review, however, bearing on the relationship

between EGM game number and problem gambling.

Bonus Features

Definition. Bonus features on EGMs, such as free games,

are added to make playing on the machines more exciting,

engaging, and to make players think that they are “getting

something for nothing.” 30 In terms of the excitement factor

of bonus rounds, a study was conducted looking at frequent-,

infrequent- and non- gamblers’ (N = 63) excitement levels (as

measured by autonomic arousal) during EGM play. Findings

showed that in addition to wins, bonus rounds did indeed

increase excitement (i.e., they elicited an increase in arousal)

for all three groups. 54

Association with problem gambling. There is some evidence

to suggest that bonus features, specifically free games, are potent

reinforcers for regular EGM players. 55 In one study, the

strategy of gamblers (N = 220) was observed during EGM

play. Results showed that players often opted for a strategy of

playing a maximum number of lines with low bets because

this increased their chance of winning bonus rounds; however,

this also resulted in more money being spent on EGM

play. Unfortunately, the data presented could not speak to

whether the effect of bonus rounds had a differential effect

on problem gamblers. 55

Programmed Gaming Features

Prize Levels and Game Outcomes

Definition. The volatility of a game can be determined by

the level or magnitude of prizes (e.g., small, medium, large),

and the number of winning combinations required to win

prizes at each level (e.g., one versus multiple). For example,

in a slot machine setting, if only one combination of symbols

can bring about a win at each prize level, there would consequently

be only three methods of winning; however, in a situation

that can increase the volatility of the game, there might

be five different combinations that bring about a small prize,

two different combinations that bring about a medium prize,

and only one combination that bring about a large prize, resulting

in eight different methods of winning. The increased

variability of the number and level of prizes impacts on the

amount of risk and unpredictability inherent in game play.

Association with problem gambling. As the number of possible

winning combinations increases for each prize level, the

probability of winning increases as well, which in turn may

affect gambling behaviour. However, little research could be

found in our literature review on the relationship between

prize levels and problem gambling. One study was identified

that looked at single- versus multiple- prize games using

simulated EGMs among a sample of university students (N

= 80). In the single-prize game condition, participants could

make a relatively safe bet or a more risky one by gambling to

win either 1) 9,000 tokens with probability of .001, or 2) zero

tokens. In the multiple-prize game condition, participants

could make a safe bet or gamble to win 1) 9,000 tokens with

probability of .0001, 2) 54 tokens with probability 0.15, or 3)

zero tokens. Results indicated that the average gambling rates

in the multiple-prize game were significantly higher than the

average gambling rates in the single-prize game (38% versus

27%, respectively). However, this difference in gambling rates

only emerged after the first 80 rounds of play. The authors

concluded that a reward structure comprised of frequent medium

prizes may prolong time spent gambling. 56

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Electronic Gaming Machines and Problem Gambling

Payout Rate

Definition. Payout rate refers to the average rate of return

on a given EGM over time. vi For example, if the payout rate

is 85%, gamblers would receive back 85% of the amount of

money inserted into an EGM. This is a long-run expected return,

however, and is unlikely to be relevant for a given gambling

session. That is, the machine does not self-correct in

order to maintain the required return in a given game. Since

a higher payout rate is associated with a higher likelihood of

winning, it is associated with an increase in the game’s excitement

value. 55 Gambling venues normally set their own payout

rate, usually based on the jurisdiction’s rules. 57

Association with problem gambling. A study exploring the

association between payout rate and problem gambling was

conducted with college students (N = 63) who did not display

symptoms of problem gambling. Using a laboratory slot

machine simulator, study participants were exposed to three

percentage payback values ranging from a relatively poor, to

a relatively good, rate of return (i.e., from 75%, to 83%, to

95%). Results revealed that the gamblers’ behaviour did not

vary as a function of the payback percentage. 58 Although this

finding has not been confirmed by other research, it is possible

that the participants were not sensitive to the experimental

conditions due to the limited amount of time they were

allowed to play the machines (i.e., maximum 15 minutes).

Win Frequency

Definition. Win frequency refers to how often wins occur

within a given EGM playing session.

Association with problem gambling. Typically, small wins

(e.g., $20) occur more frequently than do large wins (e.g., >

$100). 59 It may be the case that small EGM wins serve to keep

the player engaged in the game. Two studies in our review

were found that looked at the impact of small wins on gambling

behaviour. The first, a laboratory study, assessed high

frequency gamblers’ (N =10) behaviour with respect to win

magnitude on EGMs. Although this study did not look at the

frequency of small wins, it did examine the effects of a small

versus large win on behaviour. Results demonstrated that

players tended to increase their rate of play when small wins

occurred, while larger wins caused a break in their rate of

play. 60 The second study, conducted with regular (N = 18) and

vi Machines can also be networked so that the payout rate is calculated

across a number of machines.

occasional (N = 21) gamblers, replicated these findings in a

real gambling venue: Gamblers disrupted their play when receiving

larger wins, whereas gambling behaviour was maintained

with smaller wins. 61

EGM-based Responsible Gambling Features (RGFs)

Definition. With regard to EGMs, responsible gambling features

(RGFs) are modifications made to machines to help

players keep track of their time and/or money expenditures.

Research suggests that such RGFs may be useful because

problem gamblers, as compared to non-problem gamblers,

are less likely to budget their time and money when gambling.

They are also less likely to adhere to their budgets when

they do set them. 64 Responsible gambling features on EGMs

may include machine RGFs (e.g., on-screen clocks, displays

of betting activity in cash amounts instead of credits), time

and money limits (e.g., card-based technologies), breaks in

play, and responsible gambling messages. Each of these features

is discussed below. (Note, however, that even though

time and money expenditures are separate variables, because

all RGF evaluations to date have used both as outcome measures,

they are reported on together in the discussion that

follows).

Machine RGFs

Association with responsible gambling. In 2001, Nova Scotia

became the first province in Canada to incorporate four responsible

gambling modifications into their VLTs. These

included: 1) permanent on-screen clocks denoting time of

day, 2) displays of betting activity in cash amounts instead

of credits, 3) pop-up reminders of the total time spent playing

(occurring at 60-, 90-, and 120- minute intervals), and 4)

five-minute cash-out warnings (at 145 minutes, with a mandatory

cash-out at 150 minutes). A concomitant analysis was

conducted with non-problem and problem VLT players exploring

the efficacy of these responsible gambling modifications.

The evaluation included a pre- and post- modification

assessment of players’ awareness of the new features, changes

in their behaviour, perceptions and attitudes, and recommendations

for further improvements to the modifications.

Findings revealed that, overall, awareness of the modified

VLTs ranged from 72% at the beginning of the study, to 97%

by the third phase of the study. The feature most preferred

by all players was the onscreen clock (60%). The features

least preferred by all players were the pop-up reminders and

17


Electronic Gaming Machines and Problem Gambling

mandatory cash-outs. Taken together, the modifications were

associated with reduced length of play. However, it should

be noted that the average expenditure on each machine

did not change, meaning that due to the shortened period

of time playing, the rate of expenditure actually increased.

The behavioural changes associated with the modifications

included a decline in the frequency of losing track of time

and money while playing, and a decline in the frequency of

spending more time playing than intended. There were also

associated improvements reported in the control of expenditure.

Displaying cash totals instead of credits was the modification

rated as most effective in terms of helping players

keep track of money, although no differences were observed

between non-problem and problem gamblers in this regard.

Pop-up reminders were seen to be ineffective, since problem

gamblers tended to cash out at least once during their VLT

play (before they could be exposed to the pop up reminders),

thereby reducing this modification’s utility. 41

In 2003/04, Nova Scotia assessed, using in-person market

tests with regular VLT players, the impact of three new VLT

modifications: 1) a time-limit option, 2) a 30-minute popup

message indicating the total time spent playing, and 3) a

mandatory response requirement to continue play. The evaluation

included a pre- and post- modification assessment of

players’ awareness of the new features, changes in their behaviour,

perceptions and attitudes, and recommendations

for further improvements to the modifications. Findings

indicated that for optional time limits, 72% of players were

aware of the feature, but 98% of those who were exposed to

the feature during play did not feel it would help them manage

their budget. In terms of the 30-minute pop-up message,

75% of players were aware of the feature, but 84% of those

exposed to it during play thought it would have no impact

on their behaviour. Finally, in regard to the on-screen clock,

61% of players were aware of the feature, but 71% of those

exposed to it during play felt that it would have no impact on

their behaviour. 63

A study was also conducted in Alberta that evaluated the

effectiveness of new responsible gambling features installed

on VLTs. A quasi-experimental design was used to examine

the awareness, knowledge, attitudes, and behaviour of players

exposed to VLTs with responsible gambling features. The

features included: 1) time clocks, 2) pop-up time reminders,

3) money counters (displays that showed the amount

of money spent during play), and 4) scrolling 1-800 banner

ads. Findings revealed that while the features were noticed

by players, the majority of players indicated that they never

used the features to limit the amount of time or money spent

on gambling. Interestingly, though, a majority of players believed

that the clock and money counters were at least somewhat

effective in helping them keep track of how much time

and money they spent. Additionally, a majority of players

believed that the money counter was at least somewhat effective

in helping them decide whether to cash out or stop playing.

However, there was no difference found in the amount of

money spent by players before and after installation of VLTs

with responsible gambling features. Finally, the modifications

did not have a differential effect on problem gamblers

as compared to non-problem gamblers. The authors of the

study concluded that, overall, it could not be argued that the

responsible gambling features led to a reduction in frequency

or duration of VLT play. 64

Time and Money Limits (Card-based Technologies)

Definition. In addition to modifying EGMs with RGFs, it has

been suggested that one way to reduce problem gambling is

to enable the gambler to make reasoned decisions about their

money and time expenditure limits prior to gambling and

away from the gaming floor. 59 This is generally referred to

in the literature as “pre-commitment,” and is primarily operationalized

in the form of “smart” or “pre-commitment”

cards. 65 The cards are a laminated product similar to credit

cards that allow patrons to impose spending and other restrictions

on their play, such as setting the duration of play

38, 66

and/or a budget for a given time period.

Association with responsible gambling. Smart cards are seen as

an RGF because once pre-play limits have been programmed

onto the card, the player cannot change their mind during the

set period. 65 Moreover, because patrons must register with the

venue to receive these cards, there is an associated reduction

in anonymity which may serve to increase accountability. 66

To date, however, we could only find two studies that directly

evaluated the RGF effectiveness of smart cards.

The first study, still in progress in Nova Scotia, evaluated

the usability and usefulness of smart cards in encouraging

responsible play among a sample of non-problem and problem

VLT gamblers. Findings revealed that 50% of study participants

thought that the cards would be useful if they were

made mandatory. Moreover, irrespective of gambling status,

87% of participants supported or strongly supported having

18


Electronic Gaming Machines and Problem Gambling

the cards made mandatory for anyone wanting to play VLTs

in Nova Scotia. 67

A second, questionnaire-based study among patrons of two

Australian clubs (N = 134), assessed consumer responses to

a number of RGFs including the use of smart cards 66 The

author of the study reported that the majority of gamblers

did not believe that the cards would help them manage

their spending, although they did believe that a player activity

statement (generated from the smart card) was a useful

feature. Notwithstanding this, there was evidence to suggest

that problem gamblers were not generally inclined to use this

latter feature, thus the author recommended that other approaches

be explored. The author also concluded that more

frequent players (i.e., more at-risk gamblers) may be attracted

to the cards on the basis of their usefulness and ease with

which they can be used across machines. This in turn might

actually encourage spending and facilitate the development

of problem gambling in at-risk players. However, this concern

is potentially offset by the lack of anonymity that accompanies

the card’s use in Australian gambling venues (as many

gamblers indicated that they preferred to remain anonymous

while gambling). 66 In another examination of these data, the

author concluded that it is currently unclear whether cardbased

technologies would work as an effective RGF. 68

Breaks in Play

Definition. Breaks in play refer to the temporary suspension

or stoppage of play on an EGM after a certain period of time.

It is aimed at limiting lengthy, continuous playing sessions.

Association with responsible gambling. Research suggests

that problem gamblers find it especially difficult to stop playing

EGMs once a gambling session has begun. 41 This lack

of control is confirmed with gamblers who are considered

to be high frequency players (i.e., they play once per week

or more). 65 Given these findings, some have suggested that

EGMs be outfitted with technology that would enforce session

breaks; however, others have argued that this may not be an

effective RGF. 45 Only one research study bearing on this issue

was found in our review and it supports the latter argument.

The study was conducted in Victoria, Australia and involved

a survey of 1) EGM players, 2) venue operators, managers

and staff, and 3) industry and community stakeholders. The

purpose of the study was to assess the effectiveness of various

harm minimization strategies, including breaks in play.

Results revealed that almost all EGM players initiate breaks

in play themselves (e.g., coffee breaks, smoke breaks, etc.),

but they still think that EGM technology initiating further

breaks in play would be an effective RGF. However, venue

managers disagreed about the effectiveness of such strategies,

arguing that there is no way of determining whether the person

playing a given EGM at the time of a break is the same

person who has been playing the EGM for prolonged periods

prior to the break. Moreover, players can simply switch to

another EGM during the break, rendering this RGF more of

an inconvenience than a deterrent. 45

Responsible Gambling Messages

Definition. Many gamblers hold false beliefs about gambling

and the extent to which they can control or predict gambling

outcomes. 69, 70 They also may lose track of how much time

and money they are spending while gambling. As a result,

providing information to gamblers during play that targets

their false beliefs and makes them more aware of their time

and money expenditures has been recommended as RGFs.

Association with responsible gambling. Two studies were

found that evaluated the effects of responsible gambling messages

during play on gambling behaviour. The first, a laboratory

study, assessed the effectiveness of warning messages

intended to aid in controlling gambling. University students

(N = 120) who had previous experience with gambling were

recruited. All participants played a computerized roulette

game with imaginary money and received education discussing

irrational beliefs expressed by gamblers. Those in the experimental

condition viewed brief messages that addressed

irrational gambling beliefs while playing the game; those in

the control condition received the educational component

without any messages. Results revealed that participants in

the experimental (warning-message) condition reported significantly

fewer irrational beliefs and spent significantly less

money than did those in the control condition. 71

A second study, conducted in Sydney, Australia, explored the

effectiveness of 10 harm minimization messages with regular

and problem gamblers using questionnaires and focus groups.

The main objective of the study was to identify messages that

would have the greatest potential to trigger gamblers to consider

changing their gambling behaviour and/or call a problem

gambling helpline. Results revealed that for both regular

and problem gamblers, three messages were thought to be

more effective than the other seven. These included: a) “Have

you spent more money on gambling than you intended?”

19


Electronic Gaming Machines and Problem Gambling

b) “Are you gambling longer than planned?” and c) “Have

you ever felt bad or guilty about your gambling?” The gamblers

reported that these messages may have the potential

to encourage responsible gambling behaviour and that they

may also cause players to re-evaluate their gambling activity.

However, the second half of all 10 messages included the

tag line, “If gambling is a concern for you call (the helpline),”

which was found to be both exclusionary and extreme (since

it pertained only to problem gamblers). It therefore did not

resonate well with participants. The authors of the study concluded

that one needs to differentiate between regular and

problem gamblers when developing harm minimization

messages and approaches in order for them to be effective for

their intended audience. 72

VENUE FEATURES

In addition to the features directly associated with EGMs,

some have hypothesized that the relationship between EGMs

and problem gambling may be due in part to the features of

the venues that house the machines. Such features include

venue type, EGM accessibility, venue conveniences, venue design,

advertising, and venue-based harm minimization strategies.

What follows is a review of the literature on each of these

features.

Venue Type

Definition. Venue type refers to the kind of venue that

houses EGMs, such as casinos, racinos (racetracks with

EGMs), bars, restaurants, lounges, and hotels to name a few.

Association with problem gambling. Currently, there is very

little known about the effect that EGM venue type has on

problem gambling, as limited research could be found on the

issue in our literature review. It is quite conceivable, however,

that venue type would be related to problem gambling, as

some venues (e.g., bars) are generally more accessible than

others (e.g., casinos) and accessibility, as will be discussed

below, is positively correlated with problem gambling. Some

researchers have differentiated between clubs and hotels,

speculating that the anonymity found in the former may be a

facilitating factor for problem gambling. 46

Only one study was found in our review that speaks to this

issue, albeit tangentially. The primary focus of the study, conducted

in New South Wales, Australia, was to assess the impact

of restricting EGM accessibility. Part of the study also

involved asking participants to indicate their gambling venue

of choice. Results revealed that problem gamblers tended to

prefer clubs (i.e., private or public sporting, community, and

ex-services facilites) over hotels because they perceived them

to be more comfortable and anonymous. 73

EGM Accessibility

Number of EGMs

Definition. Patron access to gambling is dependent to some

degree on the number of EGMs located in a venue.

Association with problem gambling. Only one study was found

in our review that looked at the effect of reducing the number

of EGMs in a venue on problem gambling. The study is the

previously discussed Nova Scotia project that explored VLT

reduction in conjunction with several other modifications

(i.e., slowing speed of play, removing the stop button, and reducing

the hours of operation). 22 In this study, 800 VLTs were

removed from retail locations in Nova Scotia on November

1, 2005. Following this initiative, telephone surveys were

conducted with the general adult population (N = 600) and

VLT players specifically (N = 711). In terms of findings, the

authors of the study reported that terminal reduction resulted

in a decrease of spending for 12% of the total VLT player

base, with problem gamblers decreasing their spending by

an average of $146 per week. Similarly, VLT players reduced

their time spent playing VLTs by an average of 70 minutes per

week, with problem gamblers reducing their time spent playing

VLTs by an average of 199 minutes per week. Results also

showed that 8% of VLT players shifted gambling activities as

a result of the terminal reduction initiative, and that 50% of

VLT players were in favour of terminal reduction. 28 However,

as mentioned previously, it is unclear which change caused

the reduction in play or whether a combination of them did.

Hours of Operation

Definition. The prevalence of EGM-related problem gambling

is directly related to the degree to which patrons can

access EGMs. 38 It is therefore believed that increased hours

of operation may lead to longer durations of play and thus

greater money expenditures for problem gamblers. Given

this relationship, some regulators have recommended mandatory

venue closures to force breaks in play. 46

20


Electronic Gaming Machines and Problem Gambling

Association with problem gambling. A study conducted in

New South Wales, Australia looked at the primary impact

that restricting access to EGMs (by shutting gaming machines

down between 6 am to 9 am) had for problem gamblers,

their families, recreational gamblers, and venue managers.

The study was conducted using in-depth in-person and

telephone interviews. Findings revealed that while problem

gamblers and their families thought that the idea of a shutdown

was good in principle, in practice they did not think it

made sense as an effective harm reduction strategy. Their rationale

was that since 6 am - 9 am is actually the least popular

time to gamble, the three-hour shutdown would only affect

hard core gamblers and/or shift workers. Moreover, they considered

a three-hour shutdown to be too short a time to have

any real impact. Notably, problem gamblers also said that the

early morning timing of the shutdown actually made them

quite cynical about the government’s genuine interest in

helping problem gamblers. In contrast, the majority (72%) of

recreational gamblers supported the strategy; however, they

also contended that to be more effective, all gaming venues

should shut down during the same time period in order to

prevent people from traveling between venues. Finally, venue

managers reported a 9% reduction in total gaming machine

revenue on average during the shutdown. 73

A second Australian study also looked at the effect of enforcing

a three-hour shutdown in 13 clubs either between 4

am and 7 am, or between 6 am and 9 am, depending on the

jurisdiction. Evaluations were conducted using in-depth inperson

or telephone interviews with recreational gamblers,

self-reported problem gamblers, and club managers. Results

indicated that none of the participants found the strategy to

be effective, and the reasons cited were similar to those found

in the previous study; namely, many patrons did not visit the

site at the times selected for shutdown. The majority of club

managers reported that the shutdown impacted negatively on

their total gaming revenue, with reported reductions ranging

from 3% to 10%. Based on these findings, the authors of the

study recommended that the shutdown period be lengthened

from three to five hours, and that evaluation of the strategy

be continued. 46

A third study, conducted in Nova Scotia, was found in our

review that showed that a reduction in VLT operating hours

resulted in a decrease in problem gambling spending. In this

study, unlike the two previous ones, the closing time was set

much earlier, at midnight, as opposed to 4 am or 6 am (no

opening time was indicated). The rationale for selecting the

midnight shutdown was based on data showing that problem

gamblers in Nova Scotia were more likely to play VLTs after

midnight (i.e., 57% of moderate to problem gamblers vs. 20%

of non-problem to low-risk problem gamblers played after

midnight). To evaluate the impact of this shutdown, a survey

was administered to the general population as well as to VLT

players specifically. Findings revealed that as a result of the

midnight closure, VLT players overall reported a 5% decrease

in spending; players who previously gambled past midnight

reported a 26% reduction in spending; and problem gamblers

reported an 18% reduction in spending. An analysis of

the net revenues demonstrated that there was an estimated

reduction in revenue of 5% to 9% which resulted from the

closure. The authors of the study concluded that the change

seemed to have the desired effect of curbing problem behaviours

of those most at risk. 74

The above pattern of findings was found in a fourth study that

looked at the effect of hours of operation (boarding time) and

days of operation per year on riverboat and racino EGM use.

Using structural equation modeling with archival data collected

between 1991 and 1998 from riverboats and racinos

in Iowa, Illinois, and Missouri (N = 153 observations), the

authors of the study found that restricting boarding times resulted

in a 35% reduction in EGM gambling. 75

Venue Conveniences

ATMs

Definition. It is often thought that access to ATMs (automated

teller machines) at gaming venues can increase the risk of

problem gambling since they provide an easy opportunity to

obtain additional funds.

Association with problem gambling. There is some evidence

available to support the above contention. According to one

study, more problem gamblers compared to non-problem

gamblers reported visiting ATMs to withdraw money while

gambling. Of this group, 20% of problem gamblers indicated

that they always visited ATMs while playing. 38 Similarly, a

telephone survey probing EGM players (N = 240) in Australia

about their ability to keep within pre-committed spending

limits found that 71% admitted to exceeding these limits, especially

if they had cash on their person or they could access

it at an ATM. 59

21


Electronic Gaming Machines and Problem Gambling

In response to the above findings, a number of ATM-related

harm reduction strategies have been suggested, including

placing limits on how much one can withdraw from gaming

venue ATMs, limiting the number of withdrawals one can

make from venue ATMs, removing ATMs from the gaming

floor, and prohibiting ATMs from gaming venues altogether.

The evidence to support these suggestions has thus far been

mixed.

One interview- and survey-based study with adult residents

in 13 regions of Australia found that more self-identified

problem gamblers (60%) visited ATMs at gaming venues than

did regular gamblers (25%), recreational gamblers (13%),

and non-gamblers (5%). It also found that ATM withdrawals

of $100 or more were more common among problem gamblers

than non-problem gamblers, and that 93% and 90% of

regular and problem gamblers, respectively, spent their ATM

withdrawals at the gaming venue compared to 70% of recreational

gamblers. Notwithstanding these findings, the study

participants expressed little support for removing ATMs

from gaming venues altogether because of the inconvenience

it would pose to recreational gamblers. Notably, though, participants

did support both the notion of placing limits on the

number of ATM withdrawals one could make and the placing

of bans on credit card cash advances (86% and 72% of

participants supported these ideas, respectively). The authors

concluded that there is limited evidence to support removing

ATMs from gaming venues completely as a means to help

reduce the risk of problem gambling. Instead, they suggested

that a more effective and acceptable strategy would be to establish

daily maximum ATM withdrawal amounts. 39

A second survey conducted in Victoria, Australia looked at

EGM players’ (N = 418) attitudes, awareness, beliefs, perceptions,

challenges and behaviours relating to a number of

harm minimization strategies. It found that moderate-risk

and problem gamblers made significantly more ATM withdrawals

than non-problem or low-risk EGM players. ATM

usage was also a significant, independent predictor of problem

gambling. Furthermore, the majority of EGM players, irrespective

of their problem gambling status, felt that ATMs

should not be located in the gaming venue at all. However,

more problem gamblers (10%), as compared to non-problem

gamblers (1.5%), maintained that ATMs should be located

on the gaming floor. The authors argued that this finding

suggests that removing ATMs from the gaming floor would

not inconvenience recreational gamblers. 45

Cashing of Cheques

Definition. Cashing of cheques refers to a venue’s policy of

accepting cheques (e.g., personal, government-issued) from

patrons to assist them with accessing money for further

gambling.

Association with problem gambling. The relationship between

the ability to cash personal cheques at a gaming venue and

problem gambling does not appear to be well documented

in the literature. This may be due to the fact that many venues

prohibit cheque-cashing from occurring at all or, if they

do allow it, that many patrons are not actually aware of the

venue’s cheque-cashing policies. 11

Alcohol Service

Definition. Much of the expansion of EGM gambling is based

on the placement of machines in venues already approved

for alcohol sales. Therefore, alcohol service is often found on

the gaming floor and many casinos (outside of Canada) offer

complimentary alcoholic beverages to their patrons.

Association with problem gambling. A survey conducted in

Nova Scotia found that 74% of VLT players reported drinking

alcohol while gambling. 76 Other research has found that

gamblers who drink alcohol during play are more likely to

be problem gamblers. 77 Moreover, some studies have found

that EGM gamblers who drink even moderate amounts of

alcohol during play will spend more time gambling, will

take more risks while gambling, and will spend more money

gambling. 78-80

Research also suggests that the impact of alcohol may differ

for non-problem as opposed to problem gamblers. For example,

one VLT study was found in our review that examined

the effects of moderate alcohol intake (3 alcoholic drinks)

among community gamblers characterized as either nonproblem

gamblers or probable problem gamblers. Findings

indicated that alcohol use was associated with both greater

time spent playing VLTs and riskier betting, but only among

the probable problem gamblers. 78

A further relationship between alcohol use and problem

gambling has been noted for problem gamblers with co-morbid

alcohol problems. Some researchers argue that problem

gamblers with co-morbid alcohol problems may have more

severe gambling problems, as well as more difficulties in general

(e.g., suicidal behaviour, drug problems) when compared

to those problem gamblers without alcohol problems. 81 In

22


Electronic Gaming Machines and Problem Gambling

support of this argument, an examination of problem gamblers

who called a gambling helpline found that those problem

gamblers with alcohol problems had greater problems in

multiple areas (e.g., arrest, attempted suicide) as compared

to problem gamblers without alcohol problems. 82 No studies

were found in our review that examined the impact of restricting

alcohol in gaming venues on problem gambling.

Venue Design

Clocks and Natural Light

Definition. The majority of gaming venues do not have visible

clocks and often have little if any natural light. It has been

suggested that venues should install clocks and increase natural

light to help patrons who may dissociate from reality or

lose track of time while gambling. 11

Association with problem gambling. There is skepticism in

the field as to whether the installation of clocks and windows

would have any tangible effect on gambling behaviour. 38

Research has been conducted, however, confirming that venues

are not particularly conducive for monitoring time of day

via wall clocks and natural light. In this regard, a mail-out

and on-site survey was conducted in New South Wales assessing

club patrons’ (N = 864) awareness and perceived effectiveness

of certain responsible gambling strategies including

increasing the visibility of clocks in venues and improving

access to natural light. The results of this study indicated

that only a few respondents were able to see the time of day

on a venue wall clock without getting up from their EGM

(38%), and that even fewer could see out of a window without

getting up from their EGM (10-15%). 11

Similarly, a second survey was conducted looking at EGM

players’ (N = 418) attitudes, awareness, beliefs, perceptions,

challenges, and behaviours relating to a number of harm

minimization strategies, including placement of clocks and

windows for natural light. Results revealed that almost 25%

of EGM players indicated that they were “never” able to see

a wall clock, and 49% thought that clearly visible wall clocks

in gaming venues would be an effective measure for reducing

problem gambling. As well, the majority of EGM players

stated that they were unable to see out of a window without

getting up from their EGM, and 46% said that the introduction

of natural lighting in the gaming area would be an effective

harm minimization strategy. 45

Placement of EGMs

Definition. Some researchers have speculated that because

of their design or format, certain gaming venues (e.g., casinos)

are more conducive to player anonymity than are others.

Anonymity, in turn, is thought to increase the risk of

problem gambling since an individual can gamble as much

as they want to without their behaviour being readily noticed

by others. 46

Association with problem gambling. To date, only one laboratory

study was found in our review that explored the impact

of venue format on gambling behaviours and perceptions

with occasional (N = 60), at-risk (N = 60) and problem gamblers

(N = 60). In terms of venue format, 3 arrangements were

tested: 1) EGMs were placed on a counter (to replicate a bar

style venue), 2) EGMs were placed against the wall (similar

to a casino), and 3) EGMs were isolated in cubicles. Results

revealed that among participants who reported being influenced

by EGM arrangement, 66% indicated that the cubicle

arrangement was the one that elicited impaired control. Of

those who thought that EGM arrangement could contribute

to excessive gambling, 74% identified the cubicle arrangement

as being most problematic. Notably, problem gamblers

preferred the cubicles because they were isolated, contributed

to anonymity, and were less distracting. They also recognized,

however, that the arrangement facilitated loss of control and

resulted in excessive gambling. 83

Advertising

Prize Advertisements

Definition. Venue advertisements of EGMs may depict ordinary

people winning millions of dollars from a single coin inserted

into a slot machine. Such advertising has been argued

to create unrealistic expectations of winning large sums of

money without providing the safeguards to prevent problem

gambling. 84

Association with problem gambling. The literature on the relationship

between advertisements and problem gambling

appears to be sparse. Only one relevant study was found in

our review, but its main purpose was to look at the demographic

and clinical features of problem gamblers (N = 131).

Relevant to this discussion was the study’s focus on triggers

that provoked the urge to gamble. Results indicated that 46%

of the sample reported that gambling-related advertisements

on television, radio, and billboards triggered their gambling.

23


Electronic Gaming Machines and Problem Gambling

Moreover, those participants who were triggered by the advertising

also appeared to develop problem gambling soon

after their first play as compared to those whose gambling

was not triggered by the advertising. 85

EGM Marketing

Definition. Targeted EGM marketing involves attempts by a

gaming facility to boost EGM play by enticing players with

offers of special deals and bonuses (e.g., additional credits or

bonus rounds for play, access to special jackpots).

Association with problem gambling. No research on the relationship

between EGM marketing and problem gambling

was found in our review.

Venue-based Harm Minimization Strategies

Self-exclusion Programs

Definition. For many years, gaming venues—particularly casinos—have

offered self-exclusion (SE) programs to patrons

who wish to voluntarily ban themselves from the venues

whether that be for months, years, a lifetime, or an unspecified

period of time.

Association with responsible gambling. To date, there is little

research on the effectiveness of SE, and among the few studies

that have been done, the evidence has been mixed. One

study examined the effectiveness of a self-exclusion program

using questionnaire data from problem gamblers (N = 220)

who had self-excluded from a casino. Results indicated that

30% of participants new to the program completely stopped

gambling once enrolled. Of those who were repeat self-excluders

(i.e., they had re-entered the self-exclusion program a

second time or more), 36% reported that in their last attempt,

they broke their ban and returned to the casino; 50% admitted

to gambling on other games such as VLTs during their

ban. Overall, however, attitudes toward the program were

quite positive, with a large proportion of first time self-excluders

reporting a high rate of satisfaction (97%), and even

second time self-excluders reporting a high rate of satisfaction

(80%). 86

A second evaluation of self-exclusion programs, conducted

in Victoria, Australia, relied on face-to-face interviews with

stakeholders from industry, gaming venues, Gambler’s Help

agencies, as well as self-excluded patrons themselves. After

reviewing the results of their extensive interviews, the authors

of the study concluded that the available data on self-exclusion

was extremely limited and not focused on outcomes.

What is more, they stated that it was not possible to meaningfully

comment on compliance by venues, rates of detection,

or notification rates, and, as a result, the effectiveness of

self-exclusion as a harm minimization strategy. They further

stated that while all stakeholders want an enforceable system,

industry spends a great deal of its efforts “bluffing” about the

credibility of SE programs but does not do enough to support

their operation, such as developing systems that would actually

make them effective. 87

As with the above studies, most of the published research on

SE is casino-based. Thus, it reveals very little about the possible

effectiveness of SE from other (non-casino) EGM venues.

Nova Scotia is currently conducting a multi-phase study

that explores EGM-related SE, with a particular focus on

the ability of venue staff to accurately identify self-excluders

violating their bans. In one phase of the study, participants

consisted of EGM retailers (N = 45), designated and trained

program retail support staff (N ~ 150) and regular, local, and

non-local EGM players (N = 36). Results revealed that 35%

of the self-excluded EGM players were detected in a venue

during their ban and that the identification rate dropped to

10% when the players were non-local. 88 Findings also showed

that the accuracy of identification improved 3.4 times if the

players were local (as opposed to non-local), 2.3 times if the

report was generated later in the day and 2.8 times if the report

was generated in a private facility compared to a public

facility. The researchers attributed the difficulty in recognizing

and accurately reporting on SE participants who are violating

their ban to a number of factors, including the busy

setting of the venues, lack of any objective means of confirming

player identities, limited staff resource or interest, and SE

participants’ efforts to avoid detection. 88

Employee Awareness Education

Definition. Educating venue employees about problem and

responsible gambling is an initiative often undertaken by

gaming venues to reduce the risk of problem gambling. The

rationale behind such initiatives is that trained employees

who have direct contact with patrons may be the main conduit

for intervening with a problem gambler. 55 Some examples

of topics covered in employee awareness training include

the nature of problem gambling, recognizing the ‘red flag’/

warning signs of a problem gambler, and knowing what to do

with those observations.

24


Electronic Gaming Machines and Problem Gambling

Association with responsible gambling. While mandatory

employee awareness training programs can be found in most

gaming venues, voluntary training programs for VLT and

lottery retailers are an emerging trend. In Alberta, there is an

awards/incentive program to motivate retailers to participate

in both mandatory and voluntary training programs offered

by the province. However, no research evaluating the efficacy

of this program was identified in our review. 64 Indeed, only

one study, conducted in Quebec, was found which examined

the efficacy of staff training for EGM venues. In this research,

an awareness campaign named “As luck would have it” was

made available to gambling retailers of VLT establishments

in order to educate them about chance and randomness, the

link between misconceptions and excessive gambling, the

symptoms of problem gambling, and ways to intervene with

a problem gambler. An after-campaign evaluation revealed

that the retailers who received the training claimed to have

a better understanding of problem gambling, and had used

some of the intervention methods more often with patrons

as compared to before the training. 89

Customer Awareness Education

Definition. Many gaming facilities have undertaken initiatives

to educate patrons about problem and responsible gambling

by making pamphlets available on site and increasing

signage throughout the venue.

Association with responsible gambling. Empirical support

for customer awareness education initiatives is limited. One

study was found in our review that evaluated club patrons’

awareness and perceived effectiveness of the customer education

initiatives in 10 clubs in Sydney, Australia. Findings

revealed that there was a high level of awareness of the signage

and information measures employed. Specifically, 86%

of respondents noticed signage advising patrons of the risks

of gambling, over 70% noticed signage about the club’s responsible

gambling house policies, and over 67% noticed signage

about the chances of winning a major prize.11 However,

despite the high level of awareness, the majority of respondents

claimed that the signage had little effect on either their

gambling perceptions or behaviours. Specifically only 44%

of respondents reported that the measures were effective in

changing the way that they thought about their gambling,

and less than 20% reported that they actually reduced how

often they gambled or how much time or money they spent

doing so. Moreover, for problem gamblers, the proportion of

those who actually changed their behaviour was even lower

than the average, indicating that the initiatives were not very

effective for those most at risk. 11

A previously discussed study conducted in Alberta evaluated

the effectiveness of new responsible gambling features

installed on VLTs to mitigate problem gambling. 64 As part

of pre-test data collection (prior to installation of new VLTs

with responsible gambling features), information was gathered

about patrons’ awareness of responsible gambling signage,

as well as patrons’ responses to signage. Findings revealed

varying levels of awareness of responsible gambling

signage, with half of all sampled patrons reporting awareness

of stickers on the front of VLTs. Additionally, a majority

of players believed that signs, stickers, and posters were at

least somewhat effective in informing them about problem

gambling and about what help was available. However, almost

none of the patrons reported changes in behaviour in

response to seeing signs, posters, or stickers (e.g., by cashing

out, stopping play, leaving the venue, or calling a helpline).

Thus, while patrons indicated awareness of signage, they did

not use the information. 65

COMMUNITY ACCESSIBILITY FEATURES

A third category of features associated with EGMs and problem

gambling may be referred to as community accessibility

features. These include the number of EGM venues, proximity

of EGM venues, EGM caps, number of EGMs per capita, and

EGMs in low income areas. Following a brief description of

the background literature on community accessibility, each

of these variables will be discussed in turn.

Background. Currently, there is evidence in the research literature

suggesting a positive link between gambling opportunities

and problem gambling, both in Canada and the rest

of the world. 13,38,90-94 One example of this is found in a replication

study that compared two surveys conducted in Quebec:

The first in 1989, the second in 1996. 96, 97 Not only did the

study find past- year gambling participation rates to have

significantly increased between the two survey years (from

54% to 63%), it also found lifetime rates of pathological gambling

to have increased (from 1.2% to 2.1%). As highlighted

by the authors of the study, these increases co-occurred with

increases in opportunities to gamble on lottery tickets, casinos,

and VLTs in the province. 95 Similarly, a study in Ontario

found that gambling participation among substance abusers

25


Electronic Gaming Machines and Problem Gambling

seeking treatment nearly doubled after the introduction of

the Niagara Falls casino. 92

Further, a study conducted using Statistics Canada data

showed that those provinces with the highest density of VLTs

per 1,000 population and a permanent casino had the highest

rates of self-identified problem gamblers. 98 Moreover,

research conducted in Manitoba, where there is widespread

availability of VLTs in bars and restaurant lounges (i.e., a per

capita density of one VLT per 200 people), demonstrated that

the prevalence of problem and probable problem gambling

(5.6%) was higher than that reported in any other Canadian

province, across a number of prevalence studies. 93 Finally,

a meta-analysis of 34 studies of gambling problems among

adults in North America from 1977-1997 indicated that

problem gambling increased over time as gambling opportunities

multiplied. 99 However, it is important to note that all

of the above studies are correlational and thus do not speak

to causation.

Moreover, the above studies are predominantly based on data

collected in the early 1980s and 1990s, when gambling was first

introduced on a wide scale. More recent studies, conducted

in the last 10 years, show that there is little or no increase in

the prevalence of moderate or severe problem gambling rates.

For example, recent research in Ontario found no significant

difference in the prevalence of moderate or severe problem

gambling between 2001 and 2005. 2 Research in Quebec found

a combined problem gambling rate of 2.4% in 1996 and 1.8%

in 2002. 97,100 Research in British Columbia found that levels

of problem gambling and probable pathological gambling

among past year and weekly gamblers remained unchanged

between 1993, 1996, and 2002. 101 Research in Alberta found

similar prevalence rates of problem gambling between 1994,

1998, and 2001. Finally, research in Manitoba found a “minor”

increase in “probable pathological gambling” in 2001

(2.3%) compared to 1995 (1.9%). 102

The relative stability of problem gambling rates from 2000

onward has been explained by both the saturation and social

adaptation models of the impact of gambling exposure

on problem gambling rates. 103 The saturation model predicts

an initial increase in problem gambling rates following the

introduction of gambling opportunities, followed by a plateau.

The social adaptation model predicts a gradual plateau

in problem gambling rates, followed by a decrease as the novelty

of the new gambling opportunities diminish.

Given the conflicting correlational evidence regarding community

accessibility and problem gambling, numerous studies

have been conducted which attempt to make sense of the

underlying relationship between the two variables. These

studies are discussed below.

Number of EGM Venues

Definition. It has been suggested that the absolute number of

EGMs in a community is not as problematic as the number

of venues housing those machines.

Association with problem gambling. Dispersing gambling opportunities

over a larger area is thought to be more harmful

than consolidating gambling opportunities to a smaller area,

since the former is more likely associated with a greater number

of people having access to such opportunities. 38 Indeed,

focus groups with occasional, at-risk, and problem gamblers

(N = 99) have shown that widespread EGM distribution is

not well regarded, as it is seen to contribute to a loss of control

over gambling among those with gambling problems.

Conversely, confining machines to a limited number of locations

is seen as a factor that would promote

27, 83

control.

Another study was found in our review that supports the

above. It looked at two regions of Australia with very different

levels of community accessibility. The first region, Western

Australia, had EGMs localized in one casino; the second region,

Victoria, had EGMs located in 540 venues. Data was

obtained from community surveys undertaken to assess attitudes

and behaviours relevant to participation in gambling,

and from interviews with a variety of stakeholders. Results

revealed that compared to Western Australia (where gambling

was localized to one casino), the monetary expenditure

per adult in Victoria (where gambling was widely dispersed)

was nearly 2.5 times greater, participation rates of EGM gambling

were 17.5 times greater, and the estimate of problem

gambling was 3 times higher. 104

Proximity of EGM Venues

Definition. The proximity of EGM venues refers to the geographical

or spatial distance of EGM venues to potential

consumers.

Association with problem gambling. Venues that are conveniently

located in or near large populations can facilitate EGM

participation by increasing ease of access. A survey conducted

with community adults in the region of Suburban Canberra,

26


Electronic Gaming Machines and Problem Gambling

Australia, (N = 2,447) examined whether geographical proximity

was a significant factor influencing gambling-related

activity. The results revealed that those who lived within close

proximity (i.e., within 4 kms) of an EGM site reported greater

gambling frequency and monetary gambling expenditure

than those who lived further away. 105 Although this study did

not directly examine the relationship between proximity and

problem gambling, it does suggest that the close proximity of

EGM venues increases opportunity to gamble and, therefore,

the risk of excessive gambling. Evidence for a link between

proximity and problem gambling has been found in other

studies. In a national survey of adults in the United States

(N = 2,947), for example, it was found that respondents who

lived within 50 miles of a casino exhibited approximately

double the rate of casino gambling participation, and problem

gambling compared to respondents who lived between

51 and 250 miles away from a casino. 94

EGM Caps

Definition. The expansion of EGM availability and its link

to increased risk of problem gambling has led many jurisdictions

to impose caps on the absolute number of EGMs

allowed in a community. However, some have argued that

controls on the location of EGM gaming venues (e.g., venue

specific capping) might be a better way of reducing problems

associated with EGMs than restrictions on the absolute number

of machines per se. 38

Association with problem gambling. Only one study looking

at EGM caps was found in our review. It took place in

Victoria, Australia, where the number of EGMs was capped in

five vulnerable areas (as defined by social disadvantage, density

of EGMs per capita, and socioeconomic status). Results

showed that the capping of EGMs in these areas was not associated

with a reduction in gaming revenue. Additionally,

there was no evidence that problem gambling behaviours (as

measured by problem gambling counselling rates and other

forms of help seeking behaviour) were at all affected by the

EGM caps. 107

While no other studies have examined EGM caps, it should

be noted that policy analyst Michael O’Neil has concluded

that the removal of 3,000 machines from South Australian

venues did not affect overall net EGM revenue. Additionally,

he reported that the majority of regular and problem gamblers

did not believe that the reduction of EGM machines

had a positive effect on problem gambling in general or on

their own behaviour specifically. 37

Number of EGMs per Capita (Density)

Definition. One common definition of EGM accessibility is

the density of EGMs within a population, defined by the number

of EGMs per capita (e.g., per 1,000 people). Five EGMs

per 1,000 people can be considered relatively low, while 48

EGMs per 1,000 people can be considered quite high.

Association with problem gambling. It has been shown that

the relationship between EGM density and gambling expenditure

is quite strong. 28, 107, 108 For instance, recall the previously

discussed study conducted in Nova Scotia that looked at

the effect of reducing EGM number on problem gambling. It

found that removing 800 VLTs from retail locations throughout

the province resulted in a decrease of time and money

expenditures among both problem and non-problem VLT

players. 28

Another study, conducted in Australia, explored the association

between EGM density and gambling participation utilizing

interview data. An analysis of four regions, each with

a different per capita concentration of EGMs, showed that

the higher the concentration, the greater the participation in

EGM-related gambling. Specifically, in those areas where the

concentration of EGMs was highest, a greater proportion of

the population spent more time and money gambling than

did those in areas where the concentration was lower. 108 This

study, though, did not look at the relationship between EGM

density and problem gambling per se.

A third study was found in our review which looked at the

relationship between EGM accessibility and expenditure

in Victoria, Australia, where the government has enacted a

policy to impose caps on EGMs in disadvantaged communities.

The study used Geographical Information Systems tools

to map EGM expenditure. Results showed that there was no

direct or uniform relationship between EGM density and expenditure

or measures of social disadvantage. 109 The authors

concluded that using EGM density as a measure of accessibility

is too simplistic because it does not take into consideration

other factors, such as type or combination of gaming

machines, proximity of venues to community facilities,

consumer preferences, venues’ marketing strategies, changes

in urban and economic conditions, etc. 108 Again, however,

27


Electronic Gaming Machines and Problem Gambling

this research did not examine the relationship between EGM

density and problem gambling per se.

EGMs in Low Income Areas

Definition. Gaming facilities are often situated close to socioeconomically

disadvantaged areas, ostensibly because they

106, 110

facilitate economic development and job creation.

Association with problem gambling. Research has found that

patrons of casinos are more likely to be locals rather than

travelers. 111,112 This means that if casinos are placed in disadvantaged

communities, the local community housing the casino

may bear the biggest share of problem gambling; yet socio-economically

disadvantaged communities are least likely

to have the resources available to handle this problem. 113

A number of studies were found in our review which confirms

that EGMs do tend to be placed in low income areas

(although not all studies focused on the link between EGMs

placed in low income areas and problem gambling per se).

For example, one study combined spatial and statistical analyses

of data including youth surveys (N = 1,206) to assess 1)

whether VLT numbers varied according to socio-economic

status, and 2) what impact this might have on adolescent

gambling behaviour. The results of this study demonstrated

that VLT machines were more often located in inner-city and

lower income neighbourhoods than in neighbourhoods that

were considered more suburban and affluent. It also found

that the odds of VLT use were 40% greater for students attending

schools in neighbourhoods with high VLT access. 114

An Australian study examined the geographical distribution

of EGMs with respect to socioeconomic status and found

that there were greater concentrations of EGMs in socio-economically

deprived areas. The authors of the study described

this as an inequitable distribution, due to the fact that the

people in these areas were least able to afford this expense. 115

Similarly, an analysis of problem gambling geography in New

Zealand was performed with the aim of determining how

problem gambling services can be better provided to the population.

In doing so, the spatial distribution of gaming venues

was determined with respect to problem gambling risk

factors. Non-casino gaming machines (NCGM) were found

to be located in more socio-economically deprived areas.

For example, the two most deprived areas in New Zealand

housed approximately 35% of the total number of NCGMs,

while the two most affluent areas housed approximately 7%

of the total number of NCGMs. In addition, according to the

results obtained from the 2002/2003 New Zealand health survey,

115 the overall problem gambling rates (not just the rates

for gaming machine-associated problem gambling) were 2.3

times greater in the areas with the most socio-economic deprivation

as compared to the most affluent areas (1.9% vs.

0.8%, respectively). The authors suggested that greater local

accessibility to gaming venues with respect to problem gambling

risk should be further investigated. 112

Finally, the effect of neighbourhood disadvantage, gambling

availability, and problem gambling was examined in the

United States using a national telephone survey. Gambling

availability was defined as the distance from the nearest gambling

facility. Findings showed that relative socioeconomic

disadvantage was positively associated with frequency of

gambling (defined as the frequency with which respondents

gambled on 15 different types of gambling activities), while

close proximity of a gambling facility to a respondent’s home

(i.e., within 10 miles) was associated with problem gambling.

Although these findings are not isolated to EGM-related

gambling alone, they do suggest that increased availability of

gambling facilities may promote problem gambling in disadvantaged

communities. 106

SUMMARY

Numerous studies have attempted to shed light on the factors

that either increase, or decrease, EGM-related problem gambling.

While much has been learned from these studies, they

are not without limitations. As a result, the literature may

provide little guidance to policy makers who often have to

use this research to make timely decisions about EGMs. One

potential way to circumvent this problem is to ask what those

who have extensive experience with EGM-related problem

gambling think about the issue. That is, what do those working

in the field as well as EGM problem gamblers themselves

believe most likely contributes to problems associated with

EGMs, and what do they believe would most likely reduce

their risk. The next two chapters of this report endeavour to

do just that.

28


Electronic Gaming Machines and Problem Gambling

2 KEY INFORMANT

QUESTIONNAIRE

METHODOLOGY

Participants

A total of 69 Key Informants from across Canada and abroad

were asked to provide their opinions on EGM-related problem

gambling via questionnaires, interviews, and/or focus

groups. Key Informants included:

1.

2.

.

.

Problem gambling Researchers, identified

through the published literature and/or personal

referral;

Gaming and problem gambling Specialists

(i.e., health and problem gambling professionals,

regulators, operators), identified through

gambling governing bodies and/or personal

referral;

Problem gambling Counsellors, recruited

through addiction agencies and/or personal

referral; and

EGM Problem Gamblers, recruited through

problem gambling services.

The purpose of this chapter is to describe the questionnaire

that was administered to Key Informants and to report on

the findings that were obtained. Chapter 3 discusses the

method and results of the focus groups, while Appendices 6

and 7 cover the Counsellor Interviews. vii For a complete list

of Key Informants asked to participate in this study, please

see Appendix 1.

Response Rate

The Key Informant Researchers, Specialists, and Counsellors

were initially sent an electronic (e-mail) letter asking them

if they would like to participate in the study and fill out the

questionnaire. (Counsellors were also asked if they would

like to participate in the interviews.) The letter consisted of

a description of the study along with instructions on how to

access the questionnaire (online via a link to the Responsible

Gambling Council’s web site). A second, reminder letter

was sent to potential participants ten days later. Problem

Gamblers were asked to fill out the questionnaire when they

signed up for the focus groups.

In total, 49 Researchers and Specialists were invited to complete

the questionnaire; of that total, 25 completed it. Eight

Counsellors were invited to complete the questionnaire; five

completed it. All twelve Problem Gamblers who signed up

for the focus groups were asked to fill out the questionnaire;

all did so. viii Table 1 shows the response rate for each Key

Informant group and the Key Informants overall. As can be

seen from the table, the overall response rate for the questionnaire

was 60.9%.

Group

Researchers/

Specialists

Questionnaire

TABLE 1. Questionnaire Response Rates

Asked to

Complete

Questionnaire

(n)

Completed

Questionnaire

(n)

Response

Rate

(%)

49 25 51.0

Counsellors 8 5 62.5

Problem

Gamblers

12 12 100.0

Total 69 42 60.9

The comprehensive questionnaire given to Key Informants

was divided into two main sections, each of which is described

in detail below. Note that while the questionnaire

vii Due to the fact that the findings from the Counsellor interviews did

not add any unique information beyond the results of the questionnaire

and focus groups, they are not included in the main report.

viii Counsellors and Problem Gamblers were each given a $50 honorarium

for filling out the questionnaires and participating in the interviews

(Counsellors) and focus groups (Problem Gamblers). The honorarium was

a gift certificate to a local grocery store.

29


Electronic Gaming Machines and Problem Gambling

administered to each Key Informant group was generally the

same, due to the highly technical nature of some items, the

Counsellors and Problem Gamblers received a modified version

that had some items omitted. For a complete copy of the

questionnaire, please see Appendix 2.

Section A: Contributors to Problem Gambling

In the first section of the questionnaire, respondents were

asked to indicate, on a 5-point scale ranging from Not at all to

Extremely, their thoughts on the importance of certain EGM

features, venue features, and overall community accessibility

features as possible contributors to problem gambling.

Following this, they were asked to rank what they believed

to be the top three contributors for each area. They were then

asked to indicate any important contributor that had not

been previously mentioned. Given that all quantitative questions

were subsequently ranked, the open-ended portion of

the questionnaire requesting a top-three ranking was deemed

redundant, and thus is not included in this report. For the

open-ended responses to the question regarding additional

features not mentioned, please see Appendix 3

Section B: Modifications to Reduce Problem Gambling

In the second section of the questionnaire, respondents were

asked to indicate, on a 5-point scale ranging from Not at all to

Extremely, their opinion on how effective select modifications

to EGM features, venue features, and overall community accessibility

features would be in reducing the risk of problem

gambling. They were also asked to indicate, on a 3-point scale

ranging from Weak to Strong, their opinion on the strength

of the evidence supporting each modification. Similar to

Section A, a top-three ranking of the most effective modifications

was requested, along with any additional modification

that had not been previously mentioned. Again, given that all

quantitative questions were subsequently ranked, the openended

portion of the questionnaire requesting a top-three

ranking was deemed redundant and therefore not included

in this report. For the open-ended responses regarding additional

modifications not mentioned, please see Appendix 3.

Finally, participants were asked to give their thoughts regarding

any improvements they would make to venue-based

harm minimization strategies (i.e., self-exclusion programs,

patron information and education initiatives, and staff training

initiatives). For the sake of brevity, the findings related to

the open-ended part of this section are not included in this

report.

SECTION A: CONTRIBUTORS TO PROBLEM

GAMBLING

Data Analysis Plan

Only Researchers and Specialists were asked to complete

Section A of the questionnaire. For the most part, responses

from the group of Researchers were analyzed separately from

the group of Specialists. Given that the size of the sample was

small, very few between-group statistical comparisons were

conducted.

Section A includes 47 items that are potential contributors

to problem gambling as identified in the literature, rated on

a 5-point scale (i.e., Not at all important, Slightly important,

Moderately important, Very important, Extremely important).

All 47 items can be subsumed under one of the three areas

that form the general framework of this review; namely,

EGM features, venue features, and community accessibility

features. For each of the three framework areas, all items were

examined using two approaches: 1) Calculation and ranking

of item mean importance scores for each Key Informant

group; and 2) Thematic analysis. Below is a more detailed description

of the two analytical approaches, followed by the

results obtained from each of the three framework areas.

1) Mean Importance Scores for Each Key Informant Group

In order to determine which contributors in a given framework

area (e.g., EGM features) were seen as most and least

important, we first calculated the average (mean) score for

each contributor as well as the standard error (SE) ix . We then

ranked each items mean score against all others in the specific

framework area. Contributors were considered to be most

important if they ranked in the top quartile of items, and

least important if they ranked in the bottom quartile. For

this set of analyses, the results for Researchers and Specialists

are examined separately. Please see Appendix 4 for tables of

all rank-ordered means by Key Informant group.

ix The standard error is the standard deviation of a sampling distribution.

More generally, it indicates the amount of variation of some statistic,

in this case the mean, in units given by the question. 116

A quartile divides the sorted data set into four equal parts so that each

part represents 1/4 of the sample. Thus, the top quartile cuts off the highest

25% of data, while the bottom, or 4 th quartile, cuts off the lowest 25%.

30


Electronic Gaming Machines and Problem Gambling

2) Thematic Analysis

After examining the results of the individual item rankings

within a given framework area, we organized the items into

clusters based on functional similarities; some of which have

been previously identified in the literature. xi For example, in

the case of EGM features, we created a first grouping of items

that referred to speed of play, a second grouping of items that

referred to sensory effects, a third group of items that referred

to payment methods, and so on. Note that given the low

number of items (i.e., 6) in the third framework area (community

accessibility), we decided that an item-based analysis

was sufficient and, therefore, the thematic analysis was applied

only to the first two framework areas (i.e., EGM and

venue features).

Bi-variate correlations were conducted between individual

item means within a thematic cluster. This was done in order

to identify any clusters that contained negatively correlated

items, as these items could suppress the cluster’s mean

importance score (i.e., two negatively correlated items in a

cluster could cancel each other out). Thus, all clusters include

items that had either a significant positive correlation or no

significant correlation with each other.

A thematic mean importance score was calculated by summing

together all individual respondents’ item scores within

a given cluster and dividing by the total number of respondents.

A higher mean indicates greater thematic importance

for the respondents. We looked at 95% confidence intervals

(CIs) to determine if any of the thematic clusters were

deemed to be more important than the others, based on the

mean scores calculated for the total sample (Researchers and

Specialists combined). xii Lastly, we also looked at any possible

differences in thematic mean scores between Researchers

and Specialists using t-tests.

xi Placement of items into clusters is thematically, not statistically,

determined. As such, it is possible to group items into other thematic

arrangements.

xii The mean is essentially an estimate of central tendency. Its 95% confidence

interval indicates the range within which one can be 95% confident

that the true mean falls. For example, a mean of 2.7 with a CI:1.8 – 3.6

would indicate that the true mean falls somewhere between 1.8 and 3.6.

Thus, when determining whether two means are different, one can look to

see if their confidence intervals overlap. If they do, it is probable that the

means are no different, since they can assume the same values. If they do

not overlap, one can conclude with some degree of certainty that they are

indeed different.

31


Electronic Gaming Machines and Problem Gambling

TABLE 2. Most and Least Important EGM Contributors to Problem Gambling (Researchers)

Most Important Contributors

EGM Feature

Mean Importance

Score

(SE)

Item Rank

Fast speed of play (e.g., shorter time between initial bet and outcome) 4.54 (.18) 1 13

Direct electronic fund transfers at machine (e.g., direct debit) 4.38 (.27) 2 13

Appearance of almost winning (i.e., near-miss) 4.23 (.23) 3 13

Bill acceptors 4.15 (.36) 4 13

Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 3.92 (.29) 6 13

Player controlled stop button 3.92 (.21) 6 13

Large mixture of small, medium, and large prize values, that increases the volatility of the

game (i.e. game is less predictable)

Least Important Contributors

3.92 (.24) 6 13

N

Higher house advantage or edge (i.e., average amount per bet taken by gaming

operator)

2.54 (.35) 26 13

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 2.54 (.29) 26 13

Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of

a win occurring)

2.54 (.27) 26 13

Payout in tokens instead of cash 2.69 (.33) 23.5 13

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 2.69 (.26) 23.5 13

Payout in tickets instead of cash 2.85 (.36) 21.5 13

Type of games available on one machine (e.g., poker, video slots, keno) 2.85 (.25) 21.5 13

Results

EGM Features that Contribute to Problem Gambling

1) Mean Importance Scores for Each Key Informant Group

Researchers’ Opinions. Researchers were asked to assess the

importance of 27 EGM features in contributing to problem

gambling. The mean importance scores for these features

ranged from 4.54 to 2.54. The EGM features that were perceived

to be the most and least important contributors to

problem gambling for this group are presented in Table 2.

As can be seen from the table, fast speed of play had the highest

mean importance score (M = 4.54), followed by direct

electronic fund transfers at machine (M = 4.38), the appearance

of almost winning (M = 4.23), and bill acceptors (M =

4.15). Machines equipped with high denomination bill acceptors,

stop buttons, and variable prize value mixtures each

had identical scores (M = 3.92). Among most of these factors,

speed seems to be an underlying theme (i.e., fast speed

of play, stop button) as is method of payment (i.e., direct electronic

fund transfers, bill acceptors).

The EGM features that were seen to be the least important

contributors to problem gambling were related to the programmable

mathematical aspect of the machines. That is,

higher and lower house advantage (which reflect the average

amount that the operator takes from each bet) and lower hit

rates (which decrease the chances of a player winning on individual

spins), all shared the lowest mean scores (M = 2.54).

Other items rated among the lowest were the number (M =

2.69) and type (M = 2.85) of games available on machines,

and payouts in non-cash currencies (i.e., tickets: M = 2.85;

tokens: M = 2.69).

Specialists’ Opinions. Specialists were also asked to assess the

importance of the 27 EGM features in contributing to problem

gambling. The mean importance scores for these features

32


Electronic Gaming Machines and Problem Gambling

TABLE 3. Most and Least Important EGM Contributors to Problem Gambling (Specialists)

EGM Feature

Mean Importance

Score

(SE)

Item Rank

N

Most Important Contributors

Direct electronic fund transfers at machine (e.g., direct debit) 4.00 (.25) 1 12

Appearance of almost winning (i.e., near-miss) 3.83 (.32) 2 12

Fast speed of play (e.g., shorter time between initial bet and outcome) 3.75 (.31) 3 12

Bill acceptors 3.58 (.31) 4.5 12

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 3.58 (.31) 4.5 12

Least Important Contributors

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 2.08 (.29) 27 12

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 2.36 (.31) 26 11

Type of games available on one machine (e.g., poker, video slots, keno) 2.42 (.36) 24 12

Sound effects (i.e., music, buzzing and ringing) 2.42 (.29) 24 12

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 2.42 (.19) 24 12

Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of

a win occurring)

2.50 (.29) 22 12

Visual effects 2.58 (.29) 21 12

ranged from 4.00 to 2.08. The EGM features perceived to be

the most important and least important contributors to problem

gambling for this group are presented in Table 3.

In terms of the least important contributors, Specialists rated

items related to game options very low (i.e., number of games

on EGMs: M = 2.08; type of games available on EGMs: M =

2.42), as well as lower house advantage (M = 2.42) and lower

hit rates (M = 2.50). The Specialists also rated machine sound

(M = 2.42) and visual (M = 2.58) effects, as well as small denomination

minimum betting amounts (M = 2.36), among

the least important EGM contributors to problem gambling.

As shown, the Specialists thought that the most important

EGM contributors to problem gambling were direct electronic

fund transfers at machines (M = 4.00), followed by the

appearance of almost winning (M = 3.83), and fast speed of

play (M = 3.75). Lastly, bill acceptors and frequent presentation

of big prize symbols during play were also ranked highly

as important contributors to problem gambling (M = 3.58

for each).

33


Electronic Gaming Machines and Problem Gambling

TABLE 4. EGM Feature Thematic Mean Importance Scores (Researchers and Specialists)

Cluster

Speed of Play

Payment

Methods

EGM-based

Inducements

Betting Options

Item

- Fast speed of play (e.g., shorter time between initial bet and outcome)

- Player controlled stop button

- Bill acceptors

- Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors)

- Direct electronic fund transfers at machine (e.g., direct debit)

- Display machine activity in credits instead of cash

- Appearance of almost winning (i.e., near-miss)

- Prominent big prize advertising on machine

- Frequent presentation of big prize symbols shown during play (e.g., reel placement)

- Large denomination maximum betting amounts (e.g., $5, $10)

- Small denomination minimum betting amounts (e.g., 5¢, 10 ¢)

- Large denomination minimum betting amounts (e.g., $1, $5)

- Large range between minimum and maximum betting amounts (e.g., 1¢ to $5)

- Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines)

Thematic Mean

Importance Score

(95% CI)

3.92 (3.58-4.26)

N=25

3.72 (3.31-4.13)

N=25

3.68 (3.36-4.00)

N=25

3.21 (2.91-3.52)

N=25

Programmed

Gaming

Features

- Large mixture of small, medium, and large prize values, that increases the volatility of the

game (i.e. game is less predictable)

- Higher house advantage or edge (i.e., average amount per bet taken by gaming operator)

- Lower house advantage or edge (i.e., average amount per bet taken by gaming operator)

- Offering winning outcomes more frequently through a higher hit-rate (i.e., higher chances

of a win occurring)

- Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of a

win occurring)

- Wide variation in possible game outcomes (i.e., high outcome volatility)

2.92 (2.67-3.17)

N=25

Payout Methods

- Payout in tickets instead of cash

- Payout in tokens instead of cash

2.84 (2.33-3.35)

N=25

Sensory Effects

- Sound effects (i.e., music, buzzing and ringing)

- Visual effects (i.e., lights, colours)

2.82 (2.40-3.24)

N=25

Game

Availability

- Type of games available on one machine (e.g., poker, video slots, keno)

- Multiple game possibilities on one machine (e.g., poker, video slots, keno)

- Bonus round game features that reward players with further play on related games with

different features

2.81 (2.49-3.13)

N=25

34


Electronic Gaming Machines and Problem Gambling

2) Thematic Analysis

For this analysis, the 27 EGM feature items were grouped together

into eight clusters. Thematic mean importance scores

for each cluster, based on the total Key Informant sample

(Researchers and Specialists), are shown in Table 4 (at left).

As can be seen in the table, three thematic clusters stand out

as the most important contributors to problem gambling:

Speed of play (M = 3.92), payment methods (M = 3.72), and

EGM-based inducements (M = 3.68). Although each of these

clusters had different means, based on observation of their

confidence intervals, it appears that these three clusters were

rated significantly higher than all other clusters.

We also compared the differences between Researchers and

Specialists on their thematic mean importance scores and

found only one thematic cluster for which the groups differed

in opinion: Researchers (M = 4.23) rated speed of play as a

more important contributor to problem gambling than did

the Specialists (M = 3.60) (t = 2.09, df = 23, p


Electronic Gaming Machines and Problem Gambling

Specialists’ Opinions. Specialists also assessed the importance

of 14 venue-related features in contributing to problem gambling.

Mean importance scores for Specialists were found to

range from 3.73 to 1.91. Results are presented in Table 6.

As shown, Specialists rated ATMs on the gaming floor or close

to EGMs to be the most important contributor to problem

gambling (M = 3.73), followed by targeted player EGM marketing

(M = 3.40), and 24-hour access to EGMs within the

venue (M = 3.36). On the other hand, they rated the lack of

clocks (M = 1.91) and windows in venues (M = 2.18), and

low visibility of EGMs within venues (M = 2.27), to be the

least important contributors to problem gambling. A large

number of EGMs in the venue also received a relatively low

score (M = 2.33).

2) Thematic Analysis

The 14 venue contributors were collapsed into 5 broader

clusters: venue conveniences, EGM accessibility, advertising,

venue type, and venue design. Thematic mean importance

scores, generated from the entire sample of Researchers and

Specialists, are presented in Table 7 on the opposite page.

As can be seen from the table, although items related to

venue conveniences had the highest mean score (M = 3.53),

when considering the confidence intervals, this score was

not significantly higher than the scores for EGM accessibility,

advertising, or venue type. Items related to venue design,

however, had significantly lower scores (M = 2.29) than did

the other four thematic clusters.

When examining differences in thematic mean scores between

the two Key Informant groups, we found that EGM

accessibility was a more important cluster for Researchers

(M = 3.69) than it was for Specialists (M = 2.83) (t = 2.4,

df = 23, p


Electronic Gaming Machines and Problem Gambling

TABLE 7. Venue Feature Thematic Mean Importance Scores (Researchers and Specialists)

Cluster

Venue

Conveniences

EGM

Accessibility

Item

- ATMs located on gaming floor or close to machines

- ATMs located anywhere in the EGM venue

- Easy access to alcohol

- Large number of EGMs within venue

- 24 hour access to EGMs in venue

- Full access to EGMs for play in venue

Thematic Mean

Importance Score

(95% CI)

3.53 (3.15-3.91)

N = 24

3.28 (2.88-3.68)

N = 25

Advertising

- Frequent big prize advertising or promotion in the venue

- General gambling marketing

- Targeted player marketing for EGMs

3.19 (2.82-3.57)

N = 24

Venue Type

- EGMs located in non-dedicated gaming venue (e.g., bar, hotel)

- EGMs located in a dedicated gaming venue (e.g., casino, racetrack)

3.14 (2.78-3.50)

N = 25

Venue Design

- No clocks in venue

- No windows in venue

- Low visibility of the EGMs within the venue (e.g., hidden from view)

2.29 (1.97-2.61)

N = 24

TABLE 8. Community Accessibility Contributors to Problem

Gambling (Researchers)

TABLE 9. Community Accessibility Contributors to Problem

Gambling (Specialists)

Community Accessibility

Feature

Mean

Importance

Score

(SE)

Item

Rank

N

Community Accessibility

Feature

Mean

Importance

Score

(SE)

Item

Rank

N

Large number of community

venues (bars, lounges, casinos,

other) with EGMs

Wide dispersion of EGMs

throughout community

4.46 (.18) 1 13

4.38 (.21) 3 13

Wide dispersion of EGMs

throughout community

Large number of community

venues (bars, lounges, casinos,

other) with EGMs

3.82 (.35) 1 11

3.64 (.28) 2 11

Convenient location of EGMs

sites (e.g., close proximity to

high residential populations)

4.38 (.18) 3 13

Convenient location of EGMs

sites (e.g., close proximity to

high residential populations)

3.55 (.31) 3 11

Over concentration of EGMs in

low income neighbourhoods

4.38 (.21) 3 13

Large number of EGMs per

capita in community

3.45 (.31) 4 11

Large number of EGMs per

capita in community

4.23 (.28) 5 13

Large total number of EGMs in

community

3.36 (.34) 5 11

Large total number of EGMs in

community

4.00 (.30) 6 13

Over concentration of EGMs in

low income neighbourhoods

3.20 (.36) 6 10

37


Electronic Gaming Machines and Problem Gambling

SECTION B: MODIFICATIONS TO REDUCE

PROBLEM GAMBLING

Data Analysis Plan

Section B of the questionnaire can be broken down into

two quantitative parts. The first asked respondents about

the effectiveness of 76 potential modifications for reducing

problem gambling risk using a 5-point scale (i.e., Not at all

to Extremely effective). The second asked respondents about

the strength of the evidence supporting these 76 modifications

using a 3-point scale ranging from Weak to Strong.

Researchers, Specialists, Counsellors, and Problem Gamblers

were all asked to complete the first part of the questionnaire,

while only Researchers and Specialists were asked to complete

the second part (i.e., strength of evidence).

As with section A, after examining the results of the individual

item rankings, we organized like items into clusters

based on functional similarities. xiii All 76 modification items

in section B (across both parts) were subsumed under one

of the three general framework areas; namely, EGM features,

venue features, and community accessibility features. The

data were analyzed using the following approaches applied to

each framework area: 1) Mean effectiveness scores were calculated

for each modification within a Key Informant group;

2) Researchers’ and Specialists’ opinions on the strength of

the evidence were then tabulated for each modification; 3)

Quartile placement of top and bottom ranking items were

compared between Key Informant groups; and 4) A thematic

analysis was conducted. Below is a more detailed description

of the analytical approaches, followed by the results from

each of the three framework areas.

1) Mean Effectiveness Scores and Opinion Regarding

Evidence Strength for Each Key Informant Group

To determine which of the modifications in a given framework

area were seen as most and least effective for reducing

problem gambling risk, we employed the same approach reported

in Section A. That is, for each modification item, the

mean effectiveness score and standard error (SE) were calculated

based on a 5-point scale (Not at all effective to Extremely

effective). xiv Mean effectiveness scores were then ranked

against other items within their specific framework area. The

most effective modifications were identified as those items

which ranked in the top quartile among all items for the specific

framework area, while the least important were identified

as those that ranked in the bottom quartile. xv

In addition, after responding to each question about a

modification’s effectiveness for reducing problem gambling,

Researchers and Specialists were asked to assess the strength

of the evidence supporting the effectiveness of that modification

for reducing problem gambling risk. For each of the two

Key Informant groups, the proportion who endorsed one of

the three strength of evidence options (i.e., Weak, Moderate,

Strong) was calculated.

2) Comparisons Between Key Informant Groups

To get a sense of the similarities and differences in opinion

between the Key Informant groups, we compared quartile

rankings (i.e., 1-4) of key items (i.e., top-rated items, bottom-rated

items and other notable items, where appropriate)

across the four groups. Please see Appendix 4 for complete

tables of the rank-ordered mean effectiveness scores by Key

Informant group.

Because the Counsellors and Problem Gamblers were not

given some of the modification items, these items were omitted

from this analysis. For this set of analyses, therefore, the

Researchers’ and Specialists’ mean effectiveness scores were

subsequently re-ranked based on the shorter list of modifications

that were assessed by the Counsellors and Problem

Gamblers.

3) Thematic Analysis

After examining the results of the individual item rankings

within a given framework area, we organized like items into

clusters based on functional similarities; some of which have

xiv The standard error is the standard deviation of a sampling distribution.

More generally, it indicates the amount of variation of some statistic,

in this case the mean, in units given by the question.

xiii Placement of items into clusters is thematically, not statistically,

determined. As such, it is possible to group items into other thematic

arrangements.

xv A quartile divides the sorted data set into four equal parts so that each

part represents 1/4 of the sample. Thus, the top quartile cuts off the highest

25% of data, while the bottom, or 4 th quartile, cuts off the lowest 25%.

38


Electronic Gaming Machines and Problem Gambling

been previously identified in the literature. xvi For example, in

the case of EGM features, we created a first gro uping of items

that referred to speed of play, a second grouping of items that

referred to sensory effects, a third grouping of items that referred

to payment methods, and so on. Note that given the low

number of items (i.e., 5) in the framework area pertaining

to community accessibility, we decided that an item-based

analysis was sufficient and, therefore, thematic analysis was

applied only to the first two framework areas (i.e., EGM and

venue modifications).

Bi-variate correlations were conducted between individual

item means within a thematic cluster. This was done in order

to identify any clusters that contained negatively correlated

items, as these items could suppress the cluster’s thematic

mean effectiveness score (i.e., two negatively correlated items

in a cluster could cancel each other out). Thus, all clusters

include items that had either a significant positive correlation

or no significant correlation with each other.

A thematic mean effectiveness score was then calculated

by summing together all individual respondent item scores

within a given cluster and dividing by the total number of respondents.

A higher mean indicates greater perceived effectiveness

for that modification theme. We then looked at 95%

confidence intervals to determine if any of the total thematic

mean scores were significantly higher than the others, suggesting

greater perceived effectiveness for that thematic cluster.

xvii Lastly, we looked for any possible differences in thematic

mean scores between the four Key Informant groups

using one-way ANOVA and non-parametric testing (i.e.,

Kruskal-Wallis), where applicable.

Results

EGM Modifications to Reduce Problem Gambling

1) Mean Effectiveness Scores for Each Key Informant Group

What follows is a presentation of the most and least effective

modifications as identified by each of the four Key Informant

groups. However, for the Researchers and Specialists, we also

xvi Placement of items into clusters is thematically, not statistically,

determined. As such, it is possible to group items into other thematic

arrangements.

xvii The mean is essentially an estimate of central tendency. Its 95% confidence

interval indicates the range within which one can be 95% confident

that the true mean falls. For example, a mean of 2.7 with a CI:1.8 – 3.6

would indicate that the true mean falls somewhere between 1.8 and 3.6.

report their opinions regarding the strength of the evidence

for the most and least effective modifications.

Researchers’ Opinions. Researchers were asked to assess 46

EGM-related modifications. Table 10 on the next page shows

the modifications that they believed to be most effective,

based on each item’s mean effectiveness score and standard

error (SE). The table also presents the Researchers’ perceptions

of the strength of evidence for each modification’s

effectiveness.

As can be seen, researchers’ mean effectiveness scores ranged

from 3.77 to 1.38. The most effective modifications were those

related to restricting expenditures. The most effective item

identified was eliminating electronic fund transfers at EGMs

(M = 3.77), followed by removing bill acceptors completely

(M = 3.50), and removing only large bill acceptors (M = 3.46).

Moreover, providing mandatory (M = 3.38) and optional (M =

3.00) pre-determined spending limit capacities were also rated

very highly.

In addition, Researchers felt that restrictions based on time

would be effective, as mandatory setting of pre-determined

time limits (M = 3.15) and optional setting of pre-determined

time limits (M = 3.00) were rated very highly. Generally, of the

most effective EGM modifications, mandatory, as opposed to

optional, features scored higher. This can be seen by the top

five items, including requiring mandatory registration and use

of smart cards for play. Moreover, the top five items were all

based on externally-enforced play and expenditure restrictions.

Other items that scored highly were related to decreasing

speed of play (i.e., increasing time between the outcome of

one bet and the next bet, M = 3.31) and providing on-screen

running cash totals of amount spent (M = 3.15).

With respect to their opinions on the strength of evidence

supporting a modification’s effectiveness, there was no item

that the majority of Researchers felt had strong evidential

support. The item that Researchers believed had the strongest

supporting evidence was mandatory registration and use

of smart cards (33%). They felt that most other modifications

had either weak or moderate supporting evidence; however,

when combining the moderate and strong response options,

Thus, when determining whether two means are different, one can look

to see if their confidence intervals overlap. If they do, it is probable that

the means are no different, since they can assume the same values. If they

do not overlap, one can conclude with some degree of certainty that they

are indeed different.

39


Electronic Gaming Machines and Problem Gambling

TABLE 10. Most Effective EGM Modifications and Perceived Evidence Strength (Researchers)

EGM Modification

Eliminating electronic fund transfers at the

EGMs i.e., direct debit

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

3.77 (.36) 1 13 61.5 38.5 7.7 13

N

Removing bill acceptors from EGMs 3.50 (.36) 2 12 33.3 50.0 16.7 12

Removing large bill acceptors from EGMs

(e.g., 20 or 50 denominations)

Requiring mandatory registration and use of

smart card to begin play

Requiring players to set pre-determined

spending limits

Increasing time between the outcome of one

bet and the next bet (i.e., slowing play)

Requiring players to set a pre-determined

time limit

Providing running cash totals of amount

spent on screen

Providing an option to set personal predetermined

spending limits

Providing an option to set personal predetermined

time limits

3.46 (.33) 3.5 13 38.5 46.2 15.4 13

3.46 (.40) 3.5 13 58.3 8.0 33.3 12

3.38 (.33) 5 13 50.0 33.3 16.7 12

3.31 (.29) 6 13 53.8 46.2 0.0 13

3.15 (.30) 7.5 13 61.5 38.5 0.0 13

3.15 (.41) 7.5 13 41.7 41.7 16.7 12

3.00 (.25) 9.5 13 50.0 50.0 0.0 12

3.00 (.25) 9.5 13 61.5 38.5 0.0 13

several modifications emerged as having a relatively reasonable

evidence base. Specifically, 65% of Researchers indicated

that there was reasonable evidence to support completely

removing bill acceptors or removing large denomination bill

acceptors from EGMs, and 58.4% indicated that there was reasonable

evidence to support providing EGMs with on-screen

running cash expenditure totals. Conversely, approximately

60% of Researchers indicated that there was only weak evidence

available to support eliminating electronic fund transfers,

requiring players to set pre-determined time limits, and

providing players with an option to set pre-determined time

limits. For the Researchers’ opinions on the least effective

EGM modifications, along with their perceived strength of

evidence, please see Table 11 (at right).

As the table shows, the Researchers’ lowest mean effectiveness

scores were given to the following modifications: increasing

house advantage (M = 1.38), decreasing house advantage (M =

1.77), increasing minimum bet size (M = 1.54), and providing

a problem gambling Helpline number and message on the back

of printed payout tickets (M = 1.77). As well, while the following

modifications did not receive the lowest mean effectiveness

scores, several modifications pertaining to providing

problem/responsible gambling messaging on or through the

machines placed within the bottom quartile. In particular,

providing responsible gambling messages at the beginning of

play (M = 1.85), during play (M = 1.92) and through a player

initiated button (M = 1.92) were perceived to have minimal

effectiveness.

Consistent with their views on the least important contributors

to problem gambling, removing certain types of games (M

= 1.85) and decreasing game variety (M = 1.85) were seen as

being relatively ineffective modifications. Lastly, payouts in

cash instead of tickets and payouts in cash instead of tokens also

received low scores (M = 1.92 and M = 1.85, respectively).

Not surprisingly, those EGM modifications that Researchers

considered to be least effective were also the same modifications

that Researchers believed had weaker evidential support.

In fact, there were only two modifications that were

40


Electronic Gaming Machines and Problem Gambling

TABLE 11. Least Effective EGM Modifications and Perceived Evidence Strength (Researchers)

EGM Modification

Increasing house advantage (i.e., average

amount taken per bet by gaming operator)

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

1.38 (.18) 46 13 69.2 23.1 7.7 13

N

Increasing minimum bet size 1.54 (.14) 45 13 69.2 30.8 0.0 13

Providing Helpline number and message on

the back of printed payout ticket

Decreasing house advantage (i.e., average

amount taken per bet by gaming operator)

Providing general information about

responsible gambling on welcome screen

1.77 (.17) 43.5 13 54.5 27.3 18.2 11

1.77 (.38) 43.5 13 76.9 23.1 0.0 13

1.85 (.19) 40.0 13 66.7 8.3 25.0 12

Paying out in cash instead of tokens 1.85 (.37) 40.5 13 69.2 30.8 0.0 13

Removing some types of games from EGMs

altogether (e.g., poker, video slots, keno)

1.85 (.22) 40.5 13 75.0 25.0 0.0 12

Decreasing game variety on a machine 1.85 (.22) 40.5 13 84.6 15.4 0.0 13

Add countdown clock showing time limit

remaining

Displaying responsible gambling messages

during play

Adding responsible gaming button leading

to gambling information screens

1.92 (.27) 36.5 13 50.0 41.7 0.0 12

1.92 (.18) 36.5 13 50.0 25.0 25.0 12

1.92 (.18) 36.5 13 58.3 33.3 8.3 12

Paying out in cash instead of tickets 1.92 (.40) 36.5 13 69.2 30.8 0.0 13

rated low on effectiveness for which 25% of Researchers

claimed strong support. These two modifications were providing

general information about responsible gambling on the

welcome screen, and displaying responsible gambling messages

during play.

Specialists’ Opinions. Specialists were also asked to assess the

46 EGM modifications. Results revealed that their mean effectiveness

scores ranged from 4.00 to 1.33. Table 12 on the

following page shows the modifications that the Specialists

believed to be the most effective, and their opinions about the

strength of the evidence supporting these modifications.

As can be seen in the table, among the items perceived to

be most effective, three modifications appear to stand out

among the rest: mandatory registration/use of smart card (M

= 4.00), eliminating electronic fund transfers at EGMs (M =

3.89), and pre-determined spending limit requirements (M =

3.63). In terms of the other types of spending restrictions,

the removal of bill acceptors (M = 3.22), the removal of high

denomination bill acceptors (M = 3.11), and the mandatory

(M = 3.13) and optional (M = 3.00) setting of pre-determined

time limits were also rated very highly by the Specialists. The

remaining items included in the top quartile were providing

on-screen running cash expenditure totals (M = 3.13) and removing

stop buttons (M = 3.00).

In terms of the strength of evidence supporting the most effective

modifications, the highest proportion of Specialists

indicated that there was strong evidence for mandatory

registration and use of smart cards (25%), eliminating electronic

fund transfers at EGMs (22.2%), and removing large

bill denomination acceptors from EGMs (22.2%). Overall,

the Specialists were considerably more optimistic than the

41


Electronic Gaming Machines and Problem Gambling

TABLE 12. Most Effective EGM Modifications and Perceived Evidence Strength (Specialists)

EGM Modification

Requiring mandatory registration and use of

smart card to begin play

Eliminating electronic fund transfers at the

EGMs i.e., direct debit

Requiring players to set pre-determined

spending limits

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

4.00 (.38) 1 8 37.5 37.5 25.0 8

3.89 (.35) 2 9 33.3 44.4 22.2 9

3.63 (.32) 3 8 37.5 50.0 12.5 8

Removing bill acceptors from EGMs 3.22 (.43) 4 9 0.0 88.9 11.1 9

Providing running cash totals of amount

spent on screen

Requiring players to set a pre-determined

time limit

Removing large bill acceptors from EGMs

(e.g., 20 or 50 denominations)

Providing an option to set personal predetermined

spending limits

3.13 (.35) 5.5 8 25.0 62.5 12.5 8

3.13 (.30) 5.5 8 37.5 50.0 12.5 8

3.11 (.42) 7 9 11.1 66.7 22.2 9

3.00 (.42) 8.5 8 37.5 50.0 12.5 8

Removing player controlled stop button 3.00 (.42) 8.5 8 25.0 62.5 12.5 8

N

TABLE 13. Least Effective EGM Modifications and Perceived Evidence Strength (Specialists)

EGM Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

N

Paying out in cash instead of tickets 1.33 (.24) 45.5 9 75.0 25.0 0.0 8

Increasing minimum bet size 1.33 (.24) 45.5 9 75.0 12.5 12.5 8

Paying out in cash instead of tokens 1.38 (.26) 44 8 75.0 25.0 0.0 8

Removing some types of games from EGMs

altogether (e.g., poker, video slots, keno)

1.44 (.24) 42.5 9 88.9 11.1 0.0 9

Decreasing game variety on a machine 1.44 (.18) 42.5 9 100.0 0.0 0.0 9

Increasing the chances of a win occurring

(e.g., 8% to 30%)

1.50 (.38) 41 8 62.5 37.5 0.0 8

Toning down lights and colours 1.56 (.24) 39.5 9 100.0 0.0 0.0 9

Decreasing house advantage (i.e., average

amount taken per bet by gaming operator)

Adding countdown clock showing time limit

remaining

Increasing house advantage (i.e., average

amount taken per bet by gaming operator)

Displaying simultaneous (as opposed to

sequential) presentation of reel outcomes

1.57 (.43) 39.5 7 85.7 14.3 0.0 7

1.63 (.26) 37.5 8 75.0 25.0 0.0 8

1.63 (.50) 37.5 8 75.0 25.0 0.0 8

1.71 (.18) 36 7 71.4 28.6 0.0 7

42


Electronic Gaming Machines and Problem Gambling

Researchers were about the strength of evidence supporting

the proposed EGM modifications, as a significant majority

indicated that there was at least a moderate amount of evidence

to support the modifications believed to be most effective.

The Specialists were in unanimous (i.e., 100%) agreement

that there was moderate to strong evidence supporting

the removal of bill acceptors from EGMs.

Just below table 12, Table 13 shows the modifications that

the Specialists believed to be the least effective based on

their mean effectiveness scores and their opinion about the

strength of evidence supporting these modifications.

As the table shows, modifications perceived to be least effective

for reducing problem gambling risk included cash payouts

instead of tickets (M = 1.33) or tokens (M = 1.38) and

increasing the minimum bet size (M = 1.33). Specialists also

did not seem to think that removing some types of games from

EGMs (M = 1.44) or decreasing game variety (M = 1.44) would

be effective in reducing problem gambling. Other items rated

as being relatively ineffective included those related to increasing

and decreasing house advantage (M = 1.63 and M =

1.57, respectively), and increasing the chances of a win occurring

(M = 1.50). The rest of the items falling into the bottom

quartile included toning down lights and colours (M = 1.56),

adding countdown clocks to EGMs (M = 1.63), and displaying

simultaneous presentation of reel outcomes (M = 1.71).

In terms of evidence strength, more than three quarters of

the Specialists believed that the supporting evidence was

weak for 9 out of 11 least effective modifications, and 100%

believed that there was weak evidence to support decreasing

game variety and toning down lights and colours.

Counsellors’ Opinions. Counsellors were asked to assess the

effectiveness of 40 EGM modifications to reduce problem

gambling risk. Their mean effectiveness scores ranged widely

from 4.20 to 1.20. Table 14 presents the modifications that

Counsellors perceived to be most effective.

TABLE 14. Most Effective EGM Modifications (Counsellors)

EGM Modification

Requiring mandatory

registration and use of smart

card to begin play

Requiring players to set predetermined

spending limits

Providing an option to set

personal pre-determined

spending limits

Enforcing play stoppage, break

or interruption

Providing running cash totals of

amount spent on screen

Eliminating electronic fund

transfers at the EGMs (i.e., direct

debit)

Displaying total time of play on

screen

Mean

Effectiveness

Score

(SE)

Item

Rank

Counsellors also indicated effective modifications to be play

stoppages, breaks or interruptions (M = 3.40), and providing

on EGM screens running cash expenditure totals (M = 3.40),

time of play totals (M = 3.20), and time of day (M = 3.20).

While not scoring as highly as it did for Researchers and

Specialists, eliminating electronic fund transfers at EGMs was

rated as a relatively effective modification by Counsellors (M

= 3.40). Table 15 on the following page shows findings from

the other end of the spectrum; that is, those modifications

which Counsellors thought to be least effective.

N

4.20 (.58) 1 5

3.60 (.87) 2.5 5

3.60 (.68) 2.5 5

3.40 (.81) 5 5

3.40 (.98) 5 5

3.40 (.81) 5 5

3.20 (.92) 7.5 5

Displaying time of day on screen 3.20 (.92) 7.5 5

As evidenced in the table, Counsellors believed the most effective

EGM modification to be requiring mandatory registration/use

of smart cards to begin play (M = 4.20), which was

the only item with a mean score higher than 4.0. This modification

was followed by requiring players to set pre-determined

spending limits, and providing an option to set pre-determined

spending limits, which both received mean effectiveness

scores of 3.60.

43


Electronic Gaming Machines and Problem Gambling

As Table 15 shows, Counsellors believed that increasing players’

chances of winning (M = 1.20), decreasing their chances

of winning (M = 1.80), and reducing house advantage (M =

1.60) were among the least effective EGM modifications.

Moreover, they did not feel that cash payouts instead of tokens

(M = 1.40) or tickets (M = 1.60) would be particularly effective.

Other items with low mean effectiveness scores included

increasing the time elapsed between initial bet and outcome (M

= 1.60), raising minimum bet size (M = 1.60), reducing sound

effect volume (M = 2.00), and decreasing game variety on machines

(M = 2.00).

Problem Gamblers’ Opinions. In keeping with the Counsellors,

Problem Gamblers assessed 40 EGM modifications. Their

mean effectiveness scores also varied widely, ranging between

4.00 and 1.25. Table 16 (opposite page) presents those

modifications that Problem Gamblers perceived to be most

effective.

As indicated in the table, eliminating electronic fund transfers

(M = 4.00) and mandatory registration/use of smart cards (M

= 3.73) had the highest mean effectiveness scores. Moreover,

for the Problem Gamblers, delaying immediate access to large

wins was perceived to be among the most effective modifications

(M = 3.50), unlike for the other Key Informant groups.

However, Problem Gamblers were similar to the other Key

Informant groups in the sense that they also believed that

controls on money as opposed to time expenditures would

be more effective in reducing problem gambling. That is,

while optional and mandatory capacities to set pre-determined

spending limits made the top quartile (M = 3.25 and

M = 3.09, respectively), such time-based modifications did

not. Problem Gamblers also felt that removing bill acceptors

from EGMs (M = 3.08), as well as providing continuous onscreen

running cash totals (M = 3.17) and displaying machine

activity in cash value instead of credits (M = 3.08), were effective.

Other items receiving high mean effectiveness scores

included enforcing play stoppages, breaks, or interruptions (M

= 3.42) and eliminating bonus rounds (M = 3.08). The EGM

modifications that the Problem Gamblers thought were least

effective for reducing problem gambling risk are shown in

Table 17.

The table shows that Problem Gamblers felt that increasing

minimum bet size (M = 1.25) was the least effective modification.

They also thought that paying out in cash instead of

tickets or tokens would be relatively ineffective, as each item

received a mean score of 1.67. Manipulations to the chances

of winning--either wins overall (M = 1.67) or small wins (M

TABLE 15. Least Effective EGM Modifications (Counsellors)

EGM Modification

Increasing the chances of a win

occurring (e.g., 8% to 30%)

Paying out in cash instead of

tokens

Increasing time elapsed

between initial bet and

outcome (e.g., 2.5 to 5 sec. reel

spin)

Paying out in cash instead of

tickets

Mean

Effectiveness

Score

(SE)

= 1.73)--as well as decreasing (M = 1.83) or increasing (M =

1.92) house advantage, also received low effectiveness scores.

Other items with low mean effectiveness scores included

providing Helpline number and message on the back of payout

tickets (M = 1.55), adding a responsible gaming button to gambling

information screens (M = 1.91), and removing certain

types of games on EGMs (M = 2.00).

2) Comparisons Between Key Informant Groups

Item

Rank

Based on the quartile rankings of the mean effectiveness

scores for each Key Informant group, it appears that the Key

Informants agreed on several modifications as being the most

and least effective for reducing problem gambling risk.

Top Quartile: While there were no EGM modifications that

received the exact same ranking by all Key Informant groups,

there was some consensus in terms of their general quartile

placement. That is, five items were ranked in the top quartile

of mean effectiveness scores for each group, suggesting some

agreement between the groups regarding the modifications

N

1.20 (.20) 40 5

1.40 (.25) 39 5

1.60 (.25) 36.5 5

1.60 (.40) 36.5 5

Increasing minimum bet size 1.60 (.40) 36.5 5

Decreasing house advantage

(i.e., average amount taken per

bet by gaming operator)

Decreasing the chances of a win

occurring (e.g., 25% to 5%)

Reducing volume of sound

effects (e.g., music and ringing)

Decreasing game variety on a

machine

1.60 (.40) 36.5 5

1.80 (.37) 34 5

2.00 (.45) 32.5 5

2.00 (.55) 32.5 5

44


Electronic Gaming Machines and Problem Gambling

TABLE 16. Most Effective EGM Modifications (Problem

Gamblers)

TABLE 17. Least Effective EGM Modifications (Problem

Gamblers)

EGM Modification

Eliminating electronic fund

transfers at the EGMs e.g., direct

debit

Requiring mandatory

registration/use of smart card to

begin play

Delaying immediate access to

large wins (i.e., paying out large

wins in the form of cheques)

Enforcing play stoppage, break

or interruption

Providing an option to set

personal pre-determined

spending limits

Providing running cash totals of

amount spent on screen

Requiring players to set predetermined

spending limits

Displaying machine activity in

cash value instead of credits

Removing bill acceptors from

EGMs

Mean

Effectiveness

Score

(SE)

Item

Rank

N

4.00 (.41) 1 11

3.73 (.41) 2 11

3.50 (.42) 3 12

3.42 (.36) 4 12

3.25 (.37) 5 12

3.17 (.44) 6 12

3.09 (.37) 7 11

3.08 (.29) 9 12

3.08 (.38) 9 12

EGM Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

Increasing minimum bet size 1.25 (.13) 40 12

Providing Helpline number and

message on the back of printed

payout ticket

Paying out in cash instead of

tokens

Paying out in cash instead of

tickets

Increasing the chances of a win

occurring (e.g., 8% to 30%)

Decreasing the chances of small

wins occurring

Decreasing house advantage

(i.e., average amount taken per

bet by gaming operator)

Adding responsible gaming

button leading to gambling

information screens

Increasing house advantage (i.e.,

average amount taken per bet

by gaming operator)

N

1.55 (.21) 39 12

1.67 (.26) 37 11

1.67 (.26) 37 12

1.67 (.28) 37 11

1.73 (.27) 35 12

1.83 (.30) 34 12

1.91 (.39) 33 12

1.92 (.26) 32 11

Eliminating bonus rounds (e.g.,

further play on a different game

with different features)

3.08 (.36) 9 12

Removing some types of games

from EGMs altogether (e.g.,

poker, video slots, keno)

2.00 (.28) 31 12

45


Electronic Gaming Machines and Problem Gambling

TABLE 18. Quartile Ranking (1-4) of Select EGM Modifications by Key Informant Group

EGM Modification

Quartile Ranking by Key Informant Group

Researchers Specialists Counsellors

Problem

Gamblers

Removing bill acceptors from EGMs 1 1 2 1

Eliminating bonus rounds (e.g., further play

on a different game with different features)

Displaying machine activity in cash value

instead of credits

Delaying immediate access to large wins (i.e.,

paying out large wins in the form of cheques)

2 2 2 1

2 2 2 1

2 3 2 1

that would be most effective in reducing problem gambling.

All Key Informant groups generally believed that the most effective

modifications were mandatory registration/smart card

use, eliminating direct electronic fund transfers at EGMs, requirement

or option for players to set predetermined spending

limits, and running on-screen cash expenditure totals.

Bottom Quartile: The EGM modifications in the bottom

quartile that were agreed upon by all four Key Informant

groups included decreasing house advantage, paying out in

cash instead of tickets, paying out in cash instead of tokens,

and increasing minimum bet size. Some notable modifications

were also found between the Key Informant groups.

These are reported in Table 18, which shows the quartile

ranking (i.e., 1-4) of each modification.

As indicated in the table, Researchers, Specialists, and

Problem Gamblers all ranked removing bill acceptors from

EGMs as a highly effective modification (i.e., placed in the

top quartile), but this item was ranked lower, in the second

quartile, by Counsellors. Problem Gamblers also appeared

to believe that several modifications would be more effective

than did the Researchers, Specialists, and Counsellors.

Specifically, displaying machine activity in cash value instead

of credits, delaying immediate access to large wins (i.e., paying

out large wins in the form of cheques), and eliminating

bonus rounds, all placed in the first quartile for the Problem

Gamblers, but no higher than the second quartile for the other

three Key Informant groups.

3) Thematic Analysis

For this analysis, 36 EGM modification items were grouped

together into 11 clusters. Total thematic mean effectiveness

scores for each cluster, based on the entire Key Informant

sample (Researchers, Specialists, Counsellors, and Problem

Gamblers), are reported in Table 19 on the next page.

In looking at the table, one can see that no one thematic cluster

stands out completely from the rest; rather, a gradual increase

in thematic mean effectiveness scores can be observed.

However, modifications concerning monetary controls and

payment methods appear to be seen as more effective than

all other clusters, except for modifications concerning time

of play controls. The former set of modifications related to

controlling or limiting monetary expenditure includes items

that either directly enforce expenditure controls (e.g., eliminating

electronic fund transfers, removing bill acceptors) or

empower the player to exert self-control (e.g., requirement or

option to set pre-determined spending limits). Restrictions

on betting options, which may be seen as restrictions on

spending, however, were not viewed as effective for reducing

problem gambling. At the other end of the spectrum,

the items believed to be least effective were modifications to

the experiential and emotional characteristics of the game.

In particular, items related to programmable features, such as

manipulating house advantage, chances of winning, sensory

effects, and game type, were not seen to be as effective. Other

modifications perceived to be less effective concerned changes

to payout methods, betting options, and problem/responsible

gambling messaging on the machine.

46


Electronic Gaming Machines and Problem Gambling

TABLE 19. EGM Modification Thematic Mean Effectiveness Scores (Total Sample)

Cluster

Controls on

Money Spent

Payment

Methods

Controls on

Time Spent

Speed of Play

EGM-based

Inducements

EGM-based RGFs

Item

- Providing an option to set personal pre-determined spending limits

- Requiring players to set a pre-determined spending limit

- Requiring mandatory registration and use of smart card to begin play.

- Removing bill acceptors from EGMs

- Removing large bill acceptors EGMs (e.g., $20 or $50 denominations)

- Eliminating electronic fund transfers at the EGMs i.e., direct debit

- Displaying machine activity in cash value instead of credits

- Adding countdown clock showing time limit remaining

- Providing an option to set personal pre-determined time limits

- Requiring players to set pre-determined time limits

- Enforcing play stoppage, break or interruption

- Increasing time elapsed between initial bet and outcome (e.g., 2.5 to 5 sec. reel spin)

- Remove player controlled stop button.

- Hiding spinning reels from player’s view

- Eliminating advertising of big prizes on machines

- Providing running cash totals of amount spent on screen

- Displaying total time of play on screen

- Display time of day on screen

- Displaying responsible gambling messages during play

- Providing general information on welcome screen

- Adding responsible gaming button leading to gambling information screens

Thematic Mean

Effectiveness Score

(95% CI)

3.42 (3.09-3.75)

N = 38

3.28 (2.92-3.64)

N = 39

2.80 (2.49-3.12)

N = 38

2.58 (2.25-2.90)

N = 39

2.53 (2.19-3.01)

N = 39

2.49 (1.83-2.39)

N = 38

Sensory Effects

- Reducing volume of sound effects (e.g., music and ringing)

- Eliminating sound effects and music

- Toning down lights and colours

2.22 (1.88-2.57)

N = 39

Game

Availability

- Removing some types of games from EGMs altogether (e.g., poker, keno)

- Decreasing game variety on a machine

- Eliminating bonus rounds (e.g., further play on a different game with different features)

2.19 (1.91-2.46)

N = 39

Betting Options

Problem

Gambling Help

Messaging

Payout Methods

Programmed

Gaming Features

- Reducing maximum bet size

- Increasing minimum bet size

- Decreasing # of lines on which one can bet (e.g., 5 to 2 lines)

- Providing on-screen Helpline number and message

- Providing Helpline number and message on the back of printed payout ticket

- Delaying immediate access to large wins (i.e., paying out large wins in the form of

cheques)

- Paying out in cash instead of tokens

- Paying out in cash instead of tickets

- Decreasing house advantage (i.e., average amount taken per bet by gaming operator)

- Increasing house advantage (i.e., average amount taken per bet by gaming operator)

- Decreasing the chances of a win occurring (e.g., 25% to 5%)

- Increasing the chances of a win occurring (e.g., 8% to 30%)

- Decreasing the chances of small wins occurring

2.18 (1.94-2.42)

N = 39

2.11 (1.83-2.39)

N = 37

2.06 (1.75-2.37)

N = 39

1.99 (1.76-2.21)

N = 39

47


Electronic Gaming Machines and Problem Gambling

TABLE 20. Most Effective Venue Modifications and Perceived Evidence Strength (Researchers)

Venue Modification

Prohibiting access to funds from credit cards

at ATMs

Removing ATMs from the casino gaming

floor

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

4.00 (.32) 1 13 53.8 23.1 23.1 13

3.85 (.39) 2.5 13 33.3 41.7 25.0 12

N

Prohibiting the cashing of cheques at venue 3.85 (.36) 2.5 13 61.5 23.1 15.4 13

Removing ATMs from the casino 3.62 (.37) 4 13 33.3 41.7 25.0 12

Prohibiting access to free alcohol 3.46 (.33) 5.5 13 46.2 38.5 15.4 13

Prohibiting the service of alcohol at the EGM 3.46 (.33) 5.5 13 46.2 30.8 23.1 13

No statistically significant differences were found using an

ANOVA to compare the four Key Informant groups’ individual

thematic means. This finding suggests that there was

a general consensus in views across all four Key Informant

groups regarding the effectiveness of modifications to EGMs

for mitigating problem gambling.

Taken together, it appears that rather than manipulating the

experiential qualities of the game, the Key Informants in this

study believed that putting limits on, or empowering players

to limit their own behaviour in the face of game attractiveness

and excitement would be the most effective approaches

to reducing problem gambling. Thus, while speed of play was

seen as one of the more important contributors to problem

gambling, modifications to reduce speed were considered less

effective than modifications allowing a player to control the

potential effects of a faster game.

Venue Modifications to Reduce Problem Gambling

1) MeanEffectiveness Scores for Each Key Informant Group

What follows is a presentation of the most and least effective

venue modifications identified by the four Key Informant

groups. For the Researchers and Specialists only, we also report

on the opinions regarding the strength of the evidence

for the most and least effective modifications.

Researchers’ Opinions. Researchers were asked to assess the

effectiveness of 25 possible venue modifications that might

help reduce the risk of problem gambling. The mean effectiveness

scores for each of the 25 items ranged from 4.00 to 1.77.

The items deemed to be most effective by the Researchers, as

well as their opinions regarding the strength of the evidence

for these modifications, are presented in Table 20.

As can be seen from the table, the most effective modifications,

as judged by the Researchers, included prohibiting access

to funds from credit cards at ATMs (M = 4.00), removing

ATMs from the casino gaming floor (M = 3.85) or the casino

completely (M = 3.62), and prohibiting the cashing of cheques

at venues (M = 3.85). Moreover, restrictions on alcohol also

made the top quartile.

In terms of the evidence to support venue modifications, approximately

67% of the Researchers reported that removing

ATMs from the casino gaming floor or the casino altogether had

moderate to strong evidential support. Other modifications

for which a significant proportion of Researchers believed

that there was strong supporting evidence included prohibiting

access to funds from credit cards at ATMs (23.1%) and

prohibiting the service of alcohol at EGMs (23.1%). The item

with the weakest evidence was prohibiting cheque-cashing at

venues, with 61.5% of the Researchers indicating that they

believed the supporting evidence for this item was weak. The

modifications deemed to be least effective by the Researchers

and their opinions regarding the strength of the evidence for

these modifications are presented in Table 21.

48


Electronic Gaming Machines and Problem Gambling

TABLE 21. Least Effective Venue Modifications and Perceived Evidence Strength (Researchers)

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

N

Displaying time of day in gaming room 1.77 (.17) 25 13 66.7 25.0 8.3 12

Providing non-gaming entertainment on

site

1.92 (.31) 24 13 83.3 16.7 0.0 12

Providing windows in the gaming room 2.08 (.27) 23 13 58.3 33.3 8.3 12

Placing EGMs in a highly visible location in

the facility

2.23 (.30) 22 13 54.5 45.5 0.0 11

Reducing general gambling marketing 2.33 (.26) 21 12 58.3 41.7 0.0 12

Eliminating general gambling marketing 2.42 (.26) 20 12 66.7 33.3 0.0 12

As shown in the table, Researchers indicated that in terms of

least effective venue modifications, they did not think that

displaying time of day in the gaming room (M = 1.77) or providing

windows in the gaming room (M = 2.08) would be very

effective for reducing problem gambling risk. Nor did they

believe that reducing or eliminating general gambling marketing

would be very effective (M = 2.33 and M = 2.42, respectively).

Other items that rated low with this group were providing

non-gaming entertainment on site (M = 1.92) and placing

EGMs in a highly visible location in the facility (M = 2.23).

In terms of evidence strength, Researchers not only viewed

the above modifications to be least effective, they also felt

that there was weak or moderate evidence to support these

modifications. More than half of the Researchers believed

that there was weak evidential support for these items.

49


Electronic Gaming Machines and Problem Gambling

TABLE 22. Most Effective Venue Modifications and Perceived Evidence Strength (Specialists)

Venue Modification

Prohibiting access to funds from credit cards

at ATMs

Removing ATMs from the casino gaming

floor

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

3.75 (.37) 1 8 25.0 50.0 25.0 8

3.50 (.42) 2.5 8 12.5 37.5 50.0 8

N

Prohibiting the cashing of cheques at venue 3.50 (.50) 2.5 8 37.5 37.5 25.0 8

Removing ATMs from the casino 3.38 (.32) 4.5 8 12.5 50.0 37.5 8

Providing a self-exclusion program 3.38 (.50) 4.5 8 0.0 87.5 12.5 8

Specialists’ Opinions. Specialists were asked to assess the effectiveness

of 25 possible venue modifications that might help

reduce the risk of problem gambling. The mean effectiveness

scores for each of the 25 items ranged from 3.75 to 1.63. The

modifications that the Specialists believed to be most effective

and their opinions regarding the strength of the evidence

for these modifications are presented in Table 22.

As shown in the table, prohibiting access to funds from credit

cards at ATMs received the highest score by the Specialists (M

= 3.75), followed by removing ATMs from the casino gaming

floor, and prohibiting the cashing of cheques at venues--both of

which had mean effectiveness scores of 3.50. Removing ATMs

from the casino and providing a self-exclusion program also

made the top quartile.

the number of EGMs in a facility (M = 1.63) and capping the

number of EGMs in a facility (M = 1.63), followed by prohibiting

prize advertising at gaming venues (M = 1.75). Specialists

also believed that displaying time of day, providing windows in

gaming rooms, and eliminating or reducing general gambling

marketing would not be very effective, as all of these items

had mean effectiveness scores of 1.88.

In terms of evidential support, all of the least effective venue

modifications had 50% or more of the Specialists believing

that there was a concomitant weak evidential support base.

Interestingly, at least one person (12.5%) believed that there

was strong evidence for reducing or capping the number of

EGMs in a facility, even though these two modifications were

seen to be the least effective among the group as a whole.

In terms of evidence strength, Specialists appeared to be

more likely than Researchers to believe that there was strong

evidence to support what they believed were effective modifications.

With the exception of providing self-exclusion programs,

more than one-quarter of the Specialists believed that

their top modifications had strong supporting evidence of

effectiveness. In the case of removing ATMs from the casino

gaming floor, 50% of the Specialists claimed that there was

strong evidence to support this modification. Conversely, the

items that the Specialists believed to be least effective and

their opinions regarding the strength of the evidence for these

modifications are presented in Table 23 on the next page.

As the table shows, the modifications that received the lowest

mean effectiveness scores by the Specialists were reducing

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Electronic Gaming Machines and Problem Gambling

TABLE 23. Least Effective Venue Modifications and Perceived Evidence Strength (Specialists)

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

N

Reducing the number of EGMs in a facility 1.63 (.26) 24.5 8 62.5 25.0 12.5 8

Capping the number of EGMs in a facility 1.63 (.26) 24.5 8 50.0 37.5 12.5 8

Prohibiting prize advertising at gaming

venue

1.75 (.31) 23 8 62.5 37.5 0.0 8

Displaying time of day in gaming room 1.88 (.30) 20.5 8 50.0 50.0 0.0 8

Providing windows in the gaming room 1.88 (.40) 20.5 8 50.0 50.0 0.0 8

Eliminating general gambling marketing 1.88 (.23) 20.5 8 75.0 25.0 0.0 8

Reducing general gambling marketing 1.88 (.23) 20.5 8 75.0 25.0 0.0 8

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Electronic Gaming Machines and Problem Gambling

TABLE 24. Most Effective Venue Modifications (Counsellors)

TABLE 25. Least Effective Venue Modifications (Counsellors)

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Providing a self-exclusion

program

Restricting EGMs to dedicated

gaming venues (casino,

racetrack)

Restricting daily ATM

withdrawal amount

Prohibiting access to funds

from credit cards at ATMs

4.50 (.29) 1 4

4.20 (.37) 3 5

4.20 (.37) 3 5

4.20 (.49) 3 5

Providing non-gaming

entertainment on site

Reducing the number of EGMs

in a facility

Capping the number of EGMs

in a facility

Displaying time of day in

gaming room

Providing windows in the

gaming room

1.80 (.49) 20 5

2.60 (.81) 17 5

2.60 (.81) 17 5

2.60 (.68) 17 5

2.60 (.75) 17 5

Allowing only one ATM

withdrawal per venue visit

4.00 (.45) 5 5

Prohibiting prize advertising at

gaming venue

2.60 (.68) 17 5

Counsellors’ Opinions. Counsellors were asked to assess

the effectiveness of 20 venue modifications. Their mean effectiveness

scores ranged from 4.50 to 1.80. The items that

the Counsellors believed to be most effective are presented

in Table 24.

As can be seen in the table, the most effective venue modification

according to the Counsellors was providing self-exclusion

programs (M = 4.50). They also believed that restricting

EGMs to dedicated gaming venues (M = 4.20), limiting access

to ATMs through daily withdrawal restrictions (M = 4.20), denying

funds from credit cards at ATMs (M = 4.20), and allowing

only one ATM withdrawal per venue visit (M = 4.00) would

also be effective. Notably, these items appeared to have been

rated much higher by the Counsellors than they were by the

Researchers and Specialists. The items that the Counsellors

believed to be least effective are presented in Table 25.

As indicated in the table, one venue modification was seen

to be particularly ineffective by Counsellors: providing nongaming

entertainment on site (M = 1.80). The next lowest

items all had identical scores of 2.60. The items were: reducing

the number of EGMs in a facility, capping the number of

EGMs in a facility, displaying time of day, providing windows

in gaming rooms, and prohibiting prize advertising at gaming

venues.

Problem Gamblers’ Opinions. Like the Counsellors, the

Problem Gamblers were asked to assess the effectiveness of

20 venue modifications. In this framework area, the Problem

Gamblers, too, appeared to be somewhat more optimistic

about the effectiveness of venue modifications than were

the Researchers and Specialists. That is, Problem Gamblers’

mean effectiveness scores were considerably higher than

those of the Researchers and Specialists, ranging from 4.42

to 1.91. They also focused more on ATM access. The items

that the Problem Gamblers believed to be most effective are

presented in Table 26 on the next page.

As shown in the table, like the Counsellors, the most effective

modifications for the Problem Gamblers had means greater

than 4.0. These included prohibiting cheque-cashing at venues

(M = 4.42), restricting daily ATM withdrawal amounts (M =

4.25), allowing only one ATM withdrawal per venue visit (M =

4.25), removing ATMs from the casino altogether (M = 4.18),

and prohibiting access to funds from credit cards at ATMs (M

= 4.09). The items that the Problem Gamblers believed to be

the least effective are presented in Table 27.

As evidenced in the table, Problem Gamblers found placing

EGMs in a highly visible location in the facility (M = 1.91) to

be the least effective venue modification. They also saw providing

other non-gaming entertainment attractions on site (M

= 2.45) and restricting EGMs to dedicated gaming venues (M

= 2.45) as being less effective than the other modifications.

Lastly, providing self-exclusion programs (M = 2.67) and windows

in gaming rooms (M = 2.73) were also rated among the

least effective venue modifications.

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Electronic Gaming Machines and Problem Gambling

TABLE 26. Most Effective Venue Modifications (Problem

Gamblers)

TABLE 27. Least Effective Venue Modifications (Problem

Gamblers)

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Venue Modification

Mean

Effectiveness

Score

(SE)

Item

Rank

N

Prohibiting the cashing of

cheques at venue

4.42 (.29) 1 12

Placing EGMs in a highly

visible location in the facility

1.91 (.39) 20 11

Restricting daily ATM

withdrawal amount

4.25 (.35) 2.5 12

Providing non-gaming

entertainment on site

2.45 (.41) 18.5 12

Allowing only one ATM

withdrawal per venue visit

Removing ATMs from the

casino

Prohibiting access to funds

from credit cards at ATMs

4.25 (.35) 2.5 12

4.18 (.38) 4 11

4.09 (.44) 5 11

Restricting EGMs to dedicated

gaming venues (casino,

racetrack)

Providing a self-exclusion

program

Providing windows in the

gaming room

2.45 (.46) 18.5 11

2.67 (.41) 17 11

2.73 (.45) 16 11

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Electronic Gaming Machines and Problem Gambling

TABLE 28. Quartile Ranking (1-4) of Most Effective Venue Modifications by Key Informant Group

Venue Modification

Prohibiting access to funds from credit cards

at ATMs

Quartile Ranking by Key Informant Group

Researchers Specialists Counsellors Problem Gamblers

1 1 1 1

Prohibiting the cashing of cheques at venue 1 1 2 1

Removing ATMs from the casino 1 1 2 1

TABLE 29. Quartile Ranking (1-4) of Least Effective Venue Modifications by Key Informant Group

Venue Modification

Quartile Ranking by Key Informant Group

Researchers Specialists Counsellors Problem Gamblers

Providing windows in the gaming room 4 4 4 4

Providing non-gaming entertainment on site 4 3 4 4

Displaying time of day in gaming room 4 4 4 3

Place EGMs in a highly visible location in the

facility

4 3 3 4

2) Comparisons between Key Informant Groups

Table 28 shows the Key Informant groups’ quartile rankings

on EGM venue modifications that they deemed to be most

effective for reducing problem gambling risk.

As can be seen in the table, there was no consistency in rankings

across all Key Informant groups regarding the most effective

venue modifications, the one exception being prohibiting

access to funds from credit cards at ATMs, which was ranked in

the first quartile by all. Two other modifications placed in the

top quartile for three of the four groups: Prohibiting chequecashing

at venues and removing ATMs from the casino were

ranked in the top quartile for the Researchers, Specialists,

and Problem Gamblers, but fell slightly to the second quartile

in the Counsellors’ rankings. Table 29 shows the EGM venue

modifications that were perceived to be the least effective in

reducing problem gambling risk by Key Informant group.

As shown in the table, there was somewhat more consistency

in the rankings observed, as four items placed either in, or on,

the cusp of the fourth quartile across all four Key Informant

groups. The modifications that were perceived to be least effective

for reducing problem gambling risk were providing

windows or displaying time of day in gaming rooms, providing

non-gaming entertainment on site, and placing EGMs in

a highly visible location in the facility. Table 30 on the next

page shows some notable similarities and differences between

Key Informant group rankings that also emerged. For

Counsellors and Problem Gamblers, restricting daily ATM

withdrawal amounts and allowing only one ATM withdrawal

per venue visit ranked in the first quartile, whereas for the

Researchers and Specialists, these items ranked in the second

and third quartiles.

There was also interesting divided opinion on two other

modifications. First, the Specialists and Counsellors rated

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Electronic Gaming Machines and Problem Gambling

TABLE 30. Quartile Ranking (1-4) of Select Venue Modifications by Key Informant Group

Venue Modification

Quartile Ranking by Key Informant Group

Researchers Specialists Counsellors Problem Gamblers

Restricting daily ATM withdrawal amount 2 2 1 1

Allowing only one ATM withdrawal per venue

visit

2 3 1 1

Providing a self-exclusion program 3 1 1 4

Establishing patron information & education

initiatives in venue

4 2 2 2

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Electronic Gaming Machines and Problem Gambling

TABLE 31. Venue Modification Thematic Mean Effectiveness Scores (Total Sample)

Cluster

Venue Conveniences

Venue-based

Harm Minimization

Strategies

EGM Accessibility

Venue Type

Item

Removing ATMs from the casino

Removing ATMs from the casino gaming floor

Restricting daily ATM withdrawal amount

Allowing only one ATM withdrawal per venue visit

Prohibiting access to funds from credit cards at ATMs

Prohibiting the cashing of cheques at venue

Prohibiting access to free alcohol

Prohibiting the service of alcohol at the EGM

Providing a self-exclusion program

Establishing patron information & education initiatives in venue

Conducting venue staff training

Reducing the number of EGMs in a facility

Capping the number of EGMs in a facility

Prohibiting venues from being open 24 hours/day

Providing non-gaming entertainment on site.

Restricting EGMs to dedicated gaming venues

Thematic Mean

Importance Score

(95% CI)

3.61 (3.27-3.96)

N = 38

2.95 (2.58-3.31)

N = 38

2.77 (2.37-3.16)

N = 38

2.59 (2.23-2.95)

N = 37

Advertising*

Prohibit prize advertising in gaming venue.

2.54 (2.07-3.01)

N = 38

Venue Design

Displaying the time of day in the gaming room

Providing windows in the gaming room

Place EGMs in a highly visible location in the facility

2.27 (1.91-2.63)

N = 37

* The advertising thematic cluster includes only one item because not all of the other advertisement-related questions were answered by all participants..

self-exclusion programs very highly (i.e., in the 1st quartile),

while the Researchers and Problem Gamblers rated it in the

3rd and 4th quartiles, respectively. Second, although patron

information and education initiatives in the venues received

a relatively high 2 nd quartile ranking by the Specialists,

Counsellors, and Problem Gamblers, the Researchers appeared

to be significantly less enthused about its effectiveness,

as they ranked it in the bottom quartile.

3) Thematic Analysis

For this analysis, the 20 venue modification items were

grouped into six clusters. Total thematic mean effectiveness

scores, based on the total sample (Researchers, Specialists,

Counsellors, and Problem Gamblers), are presented in Table

31.

As can be seen from the table, all clusters had similar thematic

mean effectiveness scores, based on confidence interval

overlap. However, further examination within the venue

conveniences cluster (i.e., ATM, cheque-cashing, and alcohol)

indicates that this cluster would have resulted in a higher rating

than the other clusters had alcohol amenities not been

included. That is, using a cluster consisting of only restrictions

on ATM and cheque-cashing conveniences would have a

significantly higher thematic mean score (M = 3.77; CI: 3.40-

4.13) as compared to the rest of the clusters.

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Electronic Gaming Machines and Problem Gambling

TABLE 32. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Researchers)

Community Accessibility Modification

Limiting concentration of EGMs in low income

neighbourhoods

Restricting EGMs to destination style gaming facilities, away

from residential populations

Mean Effectiveness

Score

(SE)

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

3.69 (.31) 38.5 30.8 30.8 13

3.62 (.29) 46.2 38.5 15.4 13

N

Centralizing EGMs to one or a few locations 3.54 (.27) 38.5 46.2 15.4 13

Reducing the number of EGM facilities in a community 3.46 (.29) 53.8 15.4 30.8 13

Capping the number of EGM facilities in a community 3.08 (.31) 41.7 25.0 33.3 12

Using ANOVA to compare the four Key Informant groups’

thematic mean effectiveness scores, no statistically significant

differences emerged, which suggests that there was a

general consensus in views across all four groups regarding

the general effectiveness of venue modifications for mitigating

problem gambling.

In conclusion, similar to their opinions on EGM features,

Key Informants believed that modifications to venue features

that affect expenditure and access to funds would be the most

effective measures to reduce problem gambling risk out of

the possible venue modifications examined.

Community Accessibility Modifications to Reduce Problem

Gambling

1) Mean Effectiveness Scores for Each Key Informant Group

The last section of the questionnaire asked respondents to

rate the effectiveness of five initiatives related to restricting

community accessibility to EGMs. What follows is a presentation

of the most and least effective modifications as identified

by each of the four Key Informant groups. Again, for

the Researchers and Specialists, we also report their opinions

regarding the strength of the evidence for the most and least

effective modifications.

As shown, Researchers thought that the most effective community

accessibility modification was limiting concentration

of EGMs in low income neighbourhoods (M = 3.69) and restricting

EGMs to destination style gaming facilities away from

residential populations (M = 3.62). These were followed by

centralizing EGMs to one or a few locations (M = 3.54), and

reducing (M = 3.46) and capping (M = 3.08) the number of

EGM facilities in a community.

In terms of evidence strength, at least 30% of the Researchers

thought that there was strong support for three community

accessibility modifications: limiting concentration of EGMs in

low income neighbourhoods, reducing the number of EGM facilities

in a community, and capping the number of EGM facilities

in a community. In terms of weak support, the majority of

Researchers thought that there was insufficient evidence for

reducing the number of EGM facilities in a community (53.8%)

and restricting EGMs to destination style gaming facilities

away from residential populations (46.2%). The weak support

for this latter modification is notable given that Researchers

considered it to be one of the more effective modifications.

Researchers’ Opinions. The range of mean effectiveness scores

for the Researchers was 3.69 to 3.08, although the first four

items had fairly close scores. Results are presented in Table

32.

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Electronic Gaming Machines and Problem Gambling

TABLE 33. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Specialists)

Community Accessibility Modification

Restricting EGMs to destination style gaming facilities, away

from residential populations

Mean Effectiveness

Score

(SE)

Perceived Strength of Evidence

for Effectiveness

Weak

%

Moderate

%

Strong

%

3.00 (.46) 57.1 42.9 0.0 7

N

Reducing the number of EGM facilities in a community 2.63 (.32) 37.5 50.0 12.5 8

Centralizing EGMs to one or a few locations 2.63 (.46) 25.0 50.0 25.0 8

Limiting concentration of EGMs in low income

neighbourhoods

2.43 (.43) 25.0 75.0 0.0 8

Capping the number of EGM facilities in a community 2.38 (.38) 25.0 75.0 0.0 8

Specialists’ Opinions. Specialists also rated the effectiveness of

the five modifications to community accessibility. The mean

effectiveness scores for this Key Informant group ranged from

3.00 to 2.38. These scores were generally lower than those of

the Researchers. Results are presented in Table 33.

As seen in the table, the item considered to be most effective

by Specialists was restricting EGMs to destination style gaming

facilities away from residential populations (M = 3.00).

Reducing the number of EGM facilities and centralizing EGMs

to one or a few locations had the next highest mean effectiveness

scores (M = 2.63 each, respectively). The Specialists

thought that the least effective modifications were limiting

concentration of EGMs in low income neighbourhoods (M =

2.43) and capping EGM facilities in a community (M = 2.38).

In terms of the strength of evidence for these modifications,

Specialists appeared to be more pessimistic than Researchers.

In fact, none of the Specialists thought that there was strong

evidence for three modifications—restricting EGMs to destination

style gaming facilities, away from residential populations;

limiting concentration of EGMs in low income neighbourhoods;

and capping the number of EGM facilities in a

community—even though the first of these modifications was

considered by Specialists to be most effective. Nonetheless,

with the exception of restricting EGMs to destination gaming

facilities, at least half of the Specialists believed that there was

a moderate degree of evidence supporting the effectiveness of

the modifications.

Counsellors’ Opinions. The Counsellors’ mean effectiveness

scores for the five community accessibility modifications

had the widest range (3.80 to 2.00) of all the Key Informant

groups. Results showing their mean effectiveness scores and

standard errors are reported in Table 34 on the next page.

As the table shows, the most effective modification according

to the Counsellors was centralizing EGMs to one or a

few locations (M = 3.80). The next most effective modifications

were reducing and capping the number of EGM facilities

in a community, which both had a mean score of 3.00. The

Counsellors felt that limiting concentration of EGMs in low

income neighbourhoods (M = 2.20) and restricting EGMs to

destination style gaming facilities away from residential populations

(M = 2.00) would be the least effective modifications.

Problem Gamblers’ Opinions. Problem Gamblers were asked

to assess the effectiveness of the five modifications to EGM

community accessibility. Their mean effectiveness scores had

a tight range, from 3.75 to 3.33. The results are presented in

Table 35.

As can be seen, the most effective modifications according to

Problem Gamblers were capping the number of EGM facilities

in a community (M = 3.75) and reducing the number of EGM

facilities in a community (M = 3.73). The least effective modification

was centralizing EGMs to one or a few locations (M =

3.33). However, because the scores were so close, it is likely

that the Problem Gamblers considered these modifications

to be similarly effective in reducing problem gambling risk.

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Electronic Gaming Machines and Problem Gambling

TABLE 34. Community Accessibility Modification

Effectiveness (Counsellors)

TABLE 35. Community Accessibility Modification

Effectiveness (Problem Gamblers)

Community Accessibility

Modification

Mean

Effectiveness

Score

(SE)

N

Community Accessibility

Modification

Mean

Effectiveness

Score

(SE)

N

Centralizing EGMs to one or a

few locations

3.80 (.58) 5

Capping the number of EGM

facilities in a community

3.75 (.37) 12

Reducing the number of EGM

facilities in a community

3.00 (.84) 5

Reducing the number of EGM

facilities in a community

3.73 (.45) 11

Capping the number of EGM

facilities in a community

3.00 (.84) 5

Limiting concentration of EGMs

in low income neighbourhoods

3.58 (.43) 12

Limiting concentration of EGMs

in low income neighbourhoods

Restricting EGMs to destination

style gaming facilities, away

from residential populations

2.20 (.74) 5

2.00 (.55) 5

Restricting EGMs to destination

style gaming facilities, away

from residential populations

Centralizing EGMs to one or a

few locations

3.50 (.42) 12

3.33 (.45) 12

TABLE 36. Item Ranking of Community Accessibility Modifications by Key Informant Group

Community Accessibility Modification

Limiting concentration of EGMs in low income

neighbourhoods

Restricting EGMs to destination style gaming facilities, away

from residential populations

Item Ranking by Key Informant Group

Researchers Specialists Counsellors

Problem

Gamblers

1 4 4 3

2 1 5 4

Centralizing EGMs to one or a few locations 3 2.5 1 5

Reducing the number of EGM facilities in a community 4 2.5 2.5 2

Capping the number of EGM facilities in a community 5 5 2.5 1

2) Comparisons Between Key Informant Groups

The item rankings of community accessibility modifications

for each Key Informant group are reported in Table 36.

As indicated in the table, no one community accessibility

modification emerged as the consensus choice for most effective

modification. In fact, all four Key Informant groups

had a different number one ranked modification. Capping

the number of EGM facilities in a community was generally

rated among the most effective modifications by the

Counsellors (2.5) and Problem gamblers (1), but last for

both the Researchers and Specialists (5). Conversely, the

Researchers and Specialists tended to believe that restricting

EGMs to destination style gaming facilities away from residential

populations was one of the more effective items (ranking

of 2 and 1, respectively), while the Counsellors and Problem

Gamblers ranked it in the bottom half of the items (5 and 4,

respectively).

Despite these contrasts, it should be remembered that the

modifications for Researchers and Problem Gamblers had

very close mean effectiveness scores, which suggests that

the items were perceived rather similarly in terms of effec-

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Electronic Gaming Machines and Problem Gambling

tiveness. Thus, in general, all groups thought that reducing

the number of EGM facilities and centralizing EGMs to oneor

a few locations may be a good strategy. These items were

ranked first and second for the Specialists and Counsellors,

and, given that there was little difference between the top and

bottom mean scores for Researchers and Problem Gamblers,

respectively, we may surmise that the bottom and top items

were seen to be close in terms of effectiveness.

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Electronic Gaming Machines and Problem Gambling

3 FOCUS GROUPS WITH

PROBLEM GAMBLERS

METHODOLOGY

Two focus groups with EGM Problem Gamblers were conducted

for this study, both by Dr. Jamie Wiebe of Factz

Research. One focus group was held in Regina, Saskatchewan

(N = 4); the other in Ajax, Ontario (N = 8). Participants were

recruited via a flyer that was shown to them by the counsellor

who ran their group therapy sessions. Of the 12 participants,

7 were female, 5 were male. Most were between 40 and 50

years of age (Mean = 52; Range = 37-75).

During the focus groups, participants were first asked about

their history of gambling and problem gambling. They were

then asked to give their opinions on the three EGM framework

areas (i.e., EGM features, venue features, community

accessibility features), and the modifications in these areas

they thought would reduce EGM-related problem gambling

risk. (For more detail on what was asked in the focus groups,

please see Appendix 5.). Each focus group lasted approximately

1.5 hours. In exchange for their time, participants

were given $50 worth of gift certificates to a local grocery

store. The results of the focus groups are presented below.

Note that for the sake of brevity, only the findings relevant to

the present report are provided.

RESULTS

History of Gambling and Problem Gambling

In general, participants were first introduced to EGMs by

chance, through friends or family, out of curiosity, or because

the EGM venue was accessible. Participants reported gambling

on EGMs for approximately one to seven years before

they felt that they had developed a problem. Most reported

difficulties with slot machines only; two reported difficulties

with both slot machines and VLTs. Only a few participants

were currently gambling; most stopped because of financial

consequences or feelings of guilt, shame, or remorse.

EGM Features that Contribute to Problem Gambling

All participants felt that there were specific features associated

with EGMs that contributed to problems. Commonly mentioned

were features that increase losses, such as fast speed of

play and number of betting lines. Others talked about features

that increase the sense of control over a game’s outcome, such

as bonus rounds. Some mentioned that intermittent wins increase

the belief that wins are inevitable; similarly, some said

that new machines make them believe that an EGM is more

likely to pay out soon. Several said that the hope of winning

a large jackpot contributed to problems. Others said that the

sounds and graphics of the machines produce an adrenaline

rush.

All participants felt that EGMs create more problems than

other forms of gambling. In this regard, as stated above,

many mentioned speed of play as an important factor, in that

money is lost very quickly. Others said that EGM jackpots are

relatively large, compared, for instance, to games like blackjack.

Some talked about how the colors and movements on

the screen of EGMs create excitement. Others said that bonus

rounds create instant gratification that you do not get from

other forms of gambling. A few mentioned the random nature

of EGM games and feeling that a win is around the corner. As

one participant noted, “You keep thinking that you are going

to win. If credit goes down, you just feed the machine.” One

participant felt that EGMs were different because there is no

personal element. “If there was personal interaction, I would

take it more personally that you are taking my money and

would walk away, but it’s a machine and there is no emotional

attachment.”

Venue Features that Contribute to Problem Gambling

Participants were asked whether there were features specific

to the EGM gaming venue that they felt contributed to problems.

A few talked about the excitement and exhilaration created

from the venue’s sounds and lights. The most common

feature identified was accessibility to cash, through ATMs and

lines of credit.

Many participants noted the features of EGM venues that

they believed did not affect problem gambling. One of these

was access to alcohol. As one participant stated, “People that

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Electronic Gaming Machines and Problem Gambling

get drunk at casinos are not gamblers, they are there for fun.”

Another venue feature that some participants believed did

not contribute to problems was the number of machines at

a venue—that people with gambling problems will line up

for machines regardless, particularly if the machines have not

paid out recently. Other participants, however, felt that fewer

machines might prevent problems from developing in the

first place, with one participant stating, “You don’t become a

problem gambler if you can’t get on a machine.”

When asked what initially drew them to the EGM venue, a

few participants talked about the venue’s social aspect and

novelty; that it was a new place to experience with friends

and family. Many described the excitement created from all

of the sounds, sights and smells: “The casino was new, a new

experience. It was exciting, the big talk of the town. I felt like

a high roller—here we are, just like Vegas. I wanted to be part

of the excitement, in the now, in the know, not wanting to

miss anything.” A couple of participants said that they experienced

large wins the first few times they played slot machines

at a venue; one participant described the wins as “The

moment of reckoning: I felt invincible…heck of a lot easier

sitting in front of a slot machine than working.” Others mentioned

the anonymity as a drawing factor: “Nobody knew me.

I was allowed to be someone different…as opposed to who I

was at home, under pressure, fulfilling the roles.” One participant

talked about loneliness and hating to come home to an

empty house; the venue was a safe place to go to and, having

saved all her life, she felt that she deserved to spend money

on herself.

Community Accessibility Features that Contribute to

Problem Gambling

All participants felt strongly that increased community accessibility

to EGMs contributed to gambling problems. A few said

that they had stopped gambling and moved to an area that

did not have machines, but then they started gambling again

when machines were brought into their neighbourhood.

EGM Modifications to Reduce Problem Gambling

Participants were asked what modifications to EGMs they

thought would help reduce problems. This produced a variety

of responses. Many said that reducing the speed of play,

betting lines, and maximum bets would help. One participant

suggested having just three reels on a machine: “It is too overstimulating

with all of the lines. It would be boring with just

3 reels.” Another participant suggested limiting the number

of lines: “People feel that if they max bet, you will win more

money, especially if you are down. Limiting max bets might

not stop a problem gambler, but will take him a lot longer to

lose his house.” Many participants recommended having predetermined

spending limits. Some felt that money should be

displayed on an EGM in dollars and cents, rather than credits.

Two participants felt that pop-up messages showing the

amount of time and money spent would help: “If I knew I

was feeding the machine for X hours and putting X dollars

in, I would be walking away.” A few, however, felt that this

information would not be useful, as one participant stated, “I

knew how long I had been there and how much money I had

spent. I didn’t care.” One participant felt that having information

on the odds of winning and signs of a problem would

be beneficial. Most, however, felt that warnings wouldn’t help

“until you know what it is like to be addicted.”

Venue Modifications to Reduce Problem Gambling

When asked what modifications they would make to EGM

venues to reduce problem gambling, many participants

suggested eliminating access to money (e.g., through ATMs,

cheque-cashing, lines of credit, etc.). Some felt that having

to leave the venue to obtain additional cash would give them

time to think about what they were doing. One participant,

however, felt that while removing ATMs from gaming venues

would be a slight inconvenience, they would still leave the

venue to access more money if they wanted it. Another common

suggestion noted by participants was mandatory smart

cards that had maximum limits on the amount of money

that could be spent; participants said that the cards should

apply to all EGM venues. One participant recommended a

“no re-entry rule,” whereby if a gambler leaves the venue, he

or she cannot not re-enter it for a specified period of time.

Responding to this suggestion, another participant felt that

a no-entry rule would indeed have helped him, as he would

normally leave his bank cards in the car, enter the venue with

his cash limit, but then go back to his car for more money to

try to win back the money he had lost. Some felt that information

in the venue regarding signs of a problem and where

to find help would be helpful. Others disagreed, saying that

they would only call a helpline once they hit rock bottom,

and that “a gambler in action is focused on the machine, not

messages.”

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Electronic Gaming Machines and Problem Gambling

Community Accessibility Modifications to Reduce

Problem Gambling

In terms of community accessibility modifications, most

participants believed that EGMs should not be located in

residential areas, but that a person should have to drive to a

destination location to play them. As one participant stated,

“It’s not the absolute number of machines, but the location.

They should not be in residential areas. Once they came in

my neighbourhood, I knew I was in trouble.” A couple of participants,

however, felt that removing EGMs from residential

areas would help prevent problems, but would not help

those with problems already: “Problem gamblers will gamble

anywhere.”

The Importance of Prevention

Overall, most participants felt that it is far easier to prevent

gambling problems from developing than to reach those who

have problems already. Recommendations for prevention

included the same suggestions identified as helping those

with problems; namely, mandatory smart cards with spending

limits, eliminating access to money in the gaming venue,

displaying dollars rather than credits on the machines, and

removing EGMs from residential neighbourhoods. Another

common suggestion related to advertising; specifically, that

there should be less promotional advertising and more public

awareness advertising of the risks associated with gambling.

A number of participants also identified the importance of

targeting youth, and educating them on the risks of gambling

before they reach legal gambling age.

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Electronic Gaming Machines and Problem Gambling

4 DISCUSSION

The present study reviewed the literature and synthesized

the opinions of a cross-section of Key Informants via questionnaires

and focus groups. A number of findings emerged

which identified potential EGM-related contributors to problem

gambling, as well as possible modifications to reduce

problem gambling risk. Major findings for each of the three

framework areas (i.e., EGM features, venue features, community

accessibility features) are reviewed below, followed by a

discussion of the study’s limitations.

FINDINGS

EGM Features

Contributors

With respect to EGM features, the Researchers and Specialists

thought that fast speed of play, direct electronic fund transfers,

the appearance of near-misses, and machine bill acceptors

were the most important contributors to problem gambling.

The importance of these items was supported by a thematic

analysis which showed that features that speed up play (e.g.,

that shorten the time interval between bet and outcome), involve

faster payment methods (e.g., bill acceptors), and give

the appearance of near-misses were rated much higher in importance

than other EGM characteristics. On the other hand,

the type and number of games offered on a machine, house

advantage, and lower winning rates were thought to be the

least significant contributors to problem gambling.

Modifications

Since Key Informants identified direct electronic fund transfers

and bill acceptors at machines as the most important

EGM contributors to problem gambling, it is not surprising

that the elimination of these features were ranked among the

most effective EGM modifications to reduce problem gambling

risk. The general consensus among Key Informants

regarding direct electronic fund transfers is particularly interesting,

given that no empirical research on this topic was

found in the literature review. In this regard, the finding is

not only relevant for policy makers, but contributes uniquely

to the current knowledge base about EGM-based harm minimization

strategies.

The finding that Key Informants identified removing bill acceptors

as an effective method to reduce problem gambling

risk is supported by studies from the literature review showing

that a significant number of problem gamblers report often

or always using bill acceptors as compared to non-problem

38, 39

gamblers.

Key Informants also highly endorsed registration and use

of smart cards, mandatory (preferred) or optional setting of

pre-determined spending limits, and providing on-screen

running cash totals of amount spent. There is little doubt that

the Key Informants were very optimistic about the potential

of smart card technology to address problem gambling.

However, this endorsement needs to be assessed within some

limitations of the present study. Since no definition of “smart

card” technology was provided to Key Informants, it is not

possible to know what specific aspects of the technology they

were endorsing. “Smart card” is to some degree a global term,

which can incorporate a variety of features such as card-based

access controls, player-controlled self-limits, provider-controlled

self-limits, and self-exclusion, among other features.

Recall that of the two studies reviewed related to smart cards,

the one from Nova Scotia reported strong support for mandatory

registration and use of the cards, while the study from

Australia suggested that rather than help manage spending,

67, 68

card-based technologies might actually facilitate it.

From a broader perspective, the thematic analysis indicated

that Key Informants believed that modifications to limit access

to funds and payment method restrictions were most

likely to reduce problem gambling risk. However, although

the Researchers rated speed of play and the appearance of

near-misses as important contributors to problem gambling,

they did not rate reducing speed of play or the appearance of

near-misses as effective as imposing restrictions on spending.

This suggests that the Key Informants believed less in changing

participants’ experience of the game and more in imposing

spending controls or empowering individuals to exercise

their own self-control in their spending. The relative lack of

interest among Key Informants in decreasing speed of play is

consistent with studies reported in the literature review that

suggested speed restriction reduced gamblers’ enjoyment

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Electronic Gaming Machines and Problem Gambling

and satisfaction 22, 24-25 and was not an important harm minimization

strategy. 26

Items related to machine-based game outcomes (e.g., hit

rates), sensory stimulation (e.g., sound effects), and type of

games offered (e.g., poker) were ranked by Key Informants

among the bottom half of the areas examined. Here again,

the Key Informants appeared to be more interested in measures

that protect players from the potential risks of EGMs,

rather than in measures that might dampen their emotional

experience of playing on the machines and make them less

exciting.

While the Key Informants generally seemed to be interested

in features that control or limit player spending, it should

be noted that there were some exceptions. They gave relatively

low ratings to restrictions on betting options, but higher

ratings to reducing speed of play and the appearance of

near-misses.

Venue Features

Contributors

According to the Researchers and Specialists in this study,

the most important EGM venue contributors to problem

gambling were ATMs located on the gaming floor or close

to machines, 24-hour EGM access, and marketing targeted

directly to the EGM player. Overall, easy access to money,

via ATM machines specifically, was seen as a very important

contributor to problem gambling. Conversely, some of the

venue features normally associated with isolation and dissociation,

such as the absence of clocks and windows, were

judged to be relatively unimportant. Offering EGMs in a

dedicated gaming venue such as a racetrack or casino was

also reported to be among the least significant contributors

to problem gambling.

Modifications

Although there was relatively less consensus among the four

Key Informant groups about the most effective venue modifications

to reduce problem gambling risk, prohibiting access

to funds from debit and credit cards, disallowing chequecashing

at venues, and removing ATMs from the casino altogether

were generally seen to be among the more effective

measures. This fits somewhat with the findings in the literature

that support placing bans on credit card cash advances

and removing ATMs from the gaming floor. 45, 39 It is clear that

in addition to removing ATMs, there was considerable support

among Key Informants for introducing other forms of

ATM restrictions. These included tighter controls over withdrawal

limits which, again, was supported by research in the

literature. 39

Consistent with their views on the least important venue

contributors to problem gambling, Key Informants were in

high agreement that the least effective venue modifications

were placing EGMs in highly visible locations in the gaming

facility and providing windows and clocks in gaming rooms.

Providing non-gaming entertainment on site was also ranked

very low, suggesting that such a diversion would be ineffective

for displacing problem gambling behaviour.

Community Accessibility Features

Contributors

Overall, the community accessibility features that Key

Informants believed would be relatively more important

contributors to problem gambling were those related to EGM

distribution; that is, wide dispersion of EGMs throughout

the community, large number of community venues housing

EGMs, and convenient locations of EGM venues (e.g., close

proximity to high residential populations). Researchers generally

rated all of the community accessibility features higher

than did the Specialists.

Modifications

In terms of relative rankings, there was considerable variation

among the four Key Informant groups. There was no one

item that all groups agreed was the most effective community

accessibility modification. However, it appears that the Key

Informants as a group would agree that reducing the number

of EGM facilities and centralizing EGMs to one or a few locations

would be the most effective community accessibility

modification. Consistent with their views on the most significant

contributors to problem gambling, the Researchers and

Specialists supported the centralization of EGMs in fewer facilities,

away from residential areas, as the best way to reduce

problem gambling risk.

LIMITATIONS

There are several possible limitations to the present study that

should be acknowledged. First, the questionnaire and focus

groups gathered the opinions of Key Informants regarding

the importance of various contributors to problem gambling,

65


Electronic Gaming Machines and Problem Gambling

and the potential effectiveness of a number of modifications

to reduce problem gambling risk; it did not empirically test

these contributors or modifications directly.

Second, although the questionnaire used in the study was developed

based on a thorough review of the literature and was

subsequently reviewed and revised by experts in the field, it

did not undergo any psychometric testing. As a result, the

reliability and validity of the questionnaire is unknown.

Moreover, while many questionnaire items were very clearly

defined (e.g., hit rates) others were less so (e.g., smart cards),

limiting the definitiveness of the conclusions that could be

drawn. Further, although the range of topics covered in the

questionnaire was quite extensive, it asked respondents to

provide their opinions on items in isolation, or independent

from each other. In practical application, however, these

items interact in a potentially infinite number of ways. By focusing

on items in isolation, the questionnaire may limit the

generalizability of its findings.

Third, although every effort was made in the present study

to conduct an exhaustive review of the literature and gather

the opinions of a cross-section of Key Informants, the study

does not purport to be either definitive or representative. For

example, given the relatively small size and specialized nature

of the sector, the pool of Key Informants from which we had

to select our participants was relatively small, limiting the

number of individuals we could ask to participate. Of those

who were asked to participate, the overall response rate was

60.9%.

Finally, although two focus groups with EGM problem gamblers

were conducted for this study, it is generally ideal to

conduct at least four to six in order to increase the likelihood

that saturation will be reached (i.e., that all novel ideas

and opinions will be generated by participants). 113 Given the

consistency in findings obtained from the focus groups and

questionnaires filled out by all Key Informants in this study,

however, we have increased confidence in the integrity of our

data.

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Electronic Gaming Machines and Problem Gambling

5 SUMMARY &

CONCLUSIONS

On behalf of the Saskatchewan Liquor and Gaming Authority

(SLGA), the Responsible Gambling Council (RGC) conducted

a study on the relationship between EGMs and problem

gambling, and the modifications most likely to reduce the risk

of problem gambling among EGM users. The study reviewed

the available literature in these areas and brought together

the opinions of a cross-section of 42 Key Informants, including

Researchers in the field, Gaming and Problem Gambling

Specialists (i.e., health and problem gambling professionals,

regulators, operators), problem gambling Counsellors, and

EGM Problem Gamblers themselves.

Overall, the study showed that the current knowledge base, as

found in the literature review, regarding ways to reduce EGMrelated

problem gambling is limited and incomplete. While

most in the field would agree that a strong relationship exists

between problem gambling and EGMs, the nature and extent

of this relationship is far from clear. Even less clear, particularly

for policy makers, is the question of how best to address

the relationship. While experimental studies examining the

mechanics of EGMs provide insight into machine dynamics

and player behaviour, they often tell us little about what can

be done in actual practice. This study gathered the opinion

of those who have helped to define the field and knowledge

base, in order to elicit information that is concrete and practical,

and, ultimately, to provide assistance to policy-makers

in responding to the dilemmas posed by EGMs. However, it

should be noted that in order for this study to have real utility,

findings must be interpreted within a jurisdiction’s sociopolitical,

geographic, and economic context. xviii

The framework for this report, derived from the literature, focused

on three main areas: EGM features, venue features, and

xviii For example, if a given jurisdiction has many community EGM

sites which cannot be readily centralized, other modifications, such as

reducing EGM site operation hours, might be warranted (at least in the

interim). This might be the case even if the latter modification does not

receive the strongest endorsement by Key Informants.

community accessibility features. Key Informant opinion was

collected through in-depth questionnaires and focus groups.

Researchers, Specialists, and Problem Gamblers were asked

for their opinions about the importance of various features

in contributing to problem gambling; all Key Informants

were asked for their views on the potential effectiveness of

select modifications to reduce the risk of problem gambling.

Questionnaire data were analyzed by ranking mean item

scores and conducting thematic analyses to determine if certain

clusters of items were seen to be more important and/

or effective than others. Focus group data were assessed for

common themes. Results showed a remarkable level of agreement

among all Key Informant groups regarding the most

important contributors to problem gambling. There was less

agreement regarding the modifications that would reduce

problem gambling, although consensus was observed across

a number of them.

In a broad sense, Key Informants believed that certain

features intrinsic to EGMs contribute to the risk of problem

gambling, such as speed of play and the appearance of

near-misses. Other intrinsic features, such as the number

of games that can be played on the machines, their payout

schedules, and the house advantage were seen as less important.

When considering potential modifications, all Key

Informant groups supported changes that did not involve the

core operation of EGMs or the player’s experience of them.

The changes that were supported include the management of

money, pre-commitment, the use of smart card technology,

and restricting community access. Each of these is discussed

in more detail below.

The Management of Money

Throughout the study, the management of money emerged as

an important issue related to problem gambling. Many of the

highest ranked items and the thematic analysis focused on

the on-screen display of money (i.e., the provision of running

cash totals), access to money (through ATMs, cheque-cashing,

and direct electronic fund transfers), and the setting of

spending limits. At the least intrusive level, Key Informants

endorsed displaying dollars as opposed to credits on EGMs.

Interestingly, the issue of payouts in tickets versus tokens or

cash did not emerge as one of the most important items.

One of the most consistent opinions about effective modifications

across the Key Informant groups related to the restriction

of player access to funds; that is, restricting direct

electronic fund transfers that involve any use of credit or debit

cards—either on EGMs or on portable machines that can

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Electronic Gaming Machines and Problem Gambling

be used right at the EGM or gaming table. Although there is

currently little research available on ATM access as it relates

to problem gambling, there was a clear consensus among the

Key Informants that removing ATMs from the gaming floor

or from the premises completely would help reduce the risk

of players developing gambling problems.

While removing bill acceptors altogether or removing large

denomination bill acceptors from EGMs were rated highly

as effective modifications by the Researchers and Specialists,

these items did not receive as much endorsement from the

Counsellors or Problem Gamblers. These modifications may

be of decreasing concern as TITO (Ticket-in Ticket-out) systems

become a larger part of the EGM landscape.

Pre-commitment

The concept of pre-commitment was pioneered by Mark

Dickerson in Australia and has been adopted in a variety

of ways in recent years. The core of pre-commitment is the

creation of pre-set spending or time limits prior to the actual

gambling session. There was considerable Key Informant

support in the present study for the general creation of precommitment

initiatives for gamblers. However, while there

was support for all initiatives, the Key Informants tended

to see money limits as more effective than time limits. They

also tended to prefer mandatory requirements over optional

ones.

The Use of Smart Card Technology

The use of smart cards was one of the most highly endorsed

modifications to reduce problem gambling risk found in this

study. As discussed earlier, however, the questionnaire did

not provide a definition of smart card technology, nor did it

provide an extensive opportunity for Key Informants to elaborate

on the type of smart card system that they had in mind.

Nevertheless, at a very minimum, the Key Informants seemed

to understand that it involved a universal registration system

and a requirement to have a card for machine access. Given

that smart card systems can vary significantly on a number

of characteristics (e.g., time and money spending limits, optional/mandatory

features, type and level of enforcement),

Key Informants would, undoubtedly, have varying views on

the breadth and comprehensiveness of such systems.

Restricting Community Access

While there was no consensus amongst the study’s Key

Informants as to what might constitute the most effective

community accessibility modification, restricting the number

of EGM venues within a given community and concentrating

machines in centralized locations seems to be the preferred

options for reducing the risk of problem gambling. The Key

Informants rated the effectiveness of all the community accessibility

modifications relatively high, though, making it

difficult to clearly identify a single modification as being notably

more effective than the others.

Other Notable Observations

Strength of Evidence

Both the Researchers and the Specialists were asked to assess

the strength of evidence for each modification item within

the three framework areas. While the Specialists were more

optimistic than the Researchers were regarding such evidence,

overall, there appeared to be low levels of confidence

in the strength of the current evidence base. Moreover, there

was little connection between Key Informant perception of

evidence strength and the actual strength of evidence uncovered

in the literature review.

EGM-based Inducements

There are many features that can be programmed into EGMs

to promote further play, such as prize advertisements and free

games. While these features were mentioned many times in

the focus groups and questionnaire as contributors to problem

gambling, they did not get enough attention as modifications

to be considered top priorities. However, the frequency

of their mention suggests that many Key Informants believed

that this area warrants further consideration and study.

Responsible Gambling Messages

Rankings related to responsible gambling messages on machines

or in venues appeared in the mid-range of the thematic

rankings. This would suggest that there is reasonable support

for such messages, but little confidence that they would

have a large influence on problem gambling.

Conclusion

Taken together, the literature and opinions from this study’s

Key Informants suggest a strong relationship between EGMs

and problem gambling; however, the nature of this relationship

is unclear. Many modifications to EGM features, venue

features, and community accessibility features were readily

endorsed by Key Informants. There is now a need for further

research to assess the impact and effectiveness of these

modifications in practical application that takes into account

jurisdictional social, political, economic, and geographical

dynamics.

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Electronic Gaming Machines and Problem Gambling

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59. McDonnell-Phillips Pty Ltd. (2006). Analysis of

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61. Delfabbro, P. H., & Winefield, A. H. (1999). Pokermachine

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62. Focal Research. (2001). Technical report: 2000 regular

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63. Focal Research. (2004). 2003 NS VL responsible gaming

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64. Wynne, H. J., & Stinchfield, R. (2004). Evaluating

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65. Dickerson, M. (2003). Exploring the limits of ‘responsible

gambling’: Harm minimization or consumer

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66. Nisbet, S. (2005). Responsible gambling features of

card based technologies. International Journal of

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67. Omnifacts Bristol Research (2005). Nova Scotia player

card research project: Stage 1 research report.

Prepared for the Nova Scotia Gaming Corporation.

68. Nisbet, S. (2005). Alternative gaming machine payment

methods in Australia: Current knowledge

and future implications. International Gambling

Studies, 5(2), 229-252.

69. Fernandez-Alba Luengo, A., Labrador Encinas, F. J.,

Herranz, G, Ruiz Gonzalez; B. Fernandez Sastron,

O.; Garcia Mendoza, M. (2000). Analysis of

thought verbalization in pathological gamblers

while playing slot machines: Descriptive study.

Psicothema, 12(4), 654-660.

70. Steenbergh, T. A., Meyers, A. W., May, R. K., & Whelan,

J. P. (2002). Development and validation of

the gamblers’ belief questionnaire. Psychology of

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71. Floyd, K., Whelan, J. P., & Meyers, A. W. (2006). Use

of warning messages to modify gambling beliefs

and behavior in a laboratory investigation. Psychology

of Addictive Behaviors, 20(1), 69-74.

72. Riley-Smith, B., & Binder, J. (2003). Testing of harm

minimisation messages for gaming machines. Department

of Gaming and Racing. Sydney, NSW.

73. Australian Centre for Gambling Research (ACGR).

(2003). Evaluation of the impact of the three hour

shutdown of gaming machines. Prepared for the

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74. Corporate Research Associates. (2005). Nova Scotia

VLT time change findings report. Prepared for the

Nova Scotia Gaming Corporation.

75. Thalheimer, R., & Ali, M. M. (2003). The demand for

casino gaming. Applied Economics, 35, 907-918.

76. Focal Research. (1998). Nova Scotia video lottery

players survey 1997/98. Halifax, Nova Scotia:

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77. Welte, J. W., Barnes, G. M., Wieczorek, W. F., &

Tidwell, M. (2004). Simultaneous drinking and

gambling: A risk factor for pathological and nonpathological

gamblers. Journal of Gambling Studies,

21(3), 299-254.

78. Ellery, M., Stewart, S. H., & Loba, P. (2005). Alcohol’s

effects on video lottery terminal (VLT) play

among probably pathological and non-pathological

gamblers. Journal of Gambling Studies, 21(3),

299-324.

79. Kyngdon, A., & Dickerson, M. (1999). An experimental

study of the effect of prior alcohol consumption

on a simulated gambling activity. Addiction,

94(5), 697-707.

80. Baron, E., & Dickerson, M. (1999). Alcohol consumption

and self-control of gambling behavior.

Journal of Gambling Studies, 15(1), 3-15.

81. Stewart, S. H., & Kushner, M. G. (2003). Recent research

on the comorbidity of alcoholism and

pathological gambling. Alcoholism: Clinical and

Experimental Research, 27(2), 285-291.

82. Potenza, M. N., Steinberg, M. A., & Wu, R. (2005).

Characteristics of gambling helpline callers with

self-reported gambling and alcohol use problems.

Journal of Gambling Studies, 21(3), 233-254.

83. Ladouceur, R., Jacques, C., Sévigny, S., & Cantinotti,

M. (2005). Impact of the format, arrangement,

and availability of electronic gaming machines

outside casinos on gambling. International Gambling

Studies, 5(2), 139-154.

84. Griffiths, M. (2005). Does gambling advertising contribute

to problem gambling? International Journal

of Mental Health and Addiction, 3(2), 15-25.

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Electronic Gaming Machines and Problem Gambling

85. Grant, J. E., & Won Kim, S. (2001). Demographic and

clinical features of 131 adult pathological gamblers.

Journal of Clinical Psychiatry, 62(12), 957-

962.

86. Ladouceur, R., Jacques, C., Giroux, I., Ferland, F.,

& Leblond, J. (2000). Analysis of a casino’s selfexclusion

program. Journal of Gambling Studies,

16(4), 453-460.

87. The South Australian Centre for Economic Studies.

(2003). Evaluation of self-exclusion programs and

harm minimization measures. Prepared for the

Gambling Research Panel, Victoria.

88. Focal Research. (2004). 2004 NS VL self-exclusion

program process test. Final report. Prepared for

the Nova Scotia Gaming Corporation.

89. Ladouceur, R., Boutin, C., Doucet, C., Dumont, M.,

Provencher, M., Giroux, I., et. al. (2004). Awareness

promotion about excessive gambling among

video lottery retailers. Journal of Gambling Studies,

20(2), 181-185.

90. Jacques, C., Ladouceur, R., & Ferland, F. (2000). Impact

of availability on gambling: A longitudinal

study. Canadian Journal of Psychiatry, 45, 810-

815.

91. Room, R., Turner, N. E., & Ialomiteanu, A. (1999).

Community effects of the opening of the Niagara

casino. Addiction, 94, 1184-8.

92. Toneatto, T., Ferguson, D., & Brennan, J. (2003).

Effect of a new casino on problem gambling in

treatment-seeking substance abusers. Canadian

Journal of Psychiatry, 48(1), 40-44.

93. Cox, B. J., Kwong, J., Michaud, V., & Enns, M. W.

(2000). Problem and probable pathological gambling:

Considerations from a community survey.

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94. National Opinion Research Centre, Gemini Research,

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Associates. (1999). Gambling impact and behaviour

study. Report to the National Gambling

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95. Ladouceur, R., Jacques, C., Ferland, F., & Giroux, I.

(1999). Prevalence of problem gambling: A replication

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Psychiatry, 44,

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96. Ladouceur, R. (1991). The prevalence estimates of

pathological gambling in Quebec. Canadian

Journal of Psychiatry, 36, 732-734.

97. Ladouceur, R. (1996). The prevalence of pathological

gambling in Canada. Journal of Gambling Studies,

12(2), 129-142.

98. Cox, B. J., Yu, N., Afifi, T. O., & Ladouceur, R. (2005).

A national survey of gambling problems in Canada.

Canadian Journal of Psychiatry, 50(4), 213-

217.

99. Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1997).

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behavior in the United States and Canada: A

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100. Ladouceur, R., Jacques, C., Chevalier, S., Sévigny, S.,

& Hamel, D. (2005). Prevalence of pathological

gambling in Quebec in 2002. Canadian Journal of

Psychiatry, 50,

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101. Ministry of Public Safety and Solicitor General.

(2003). British Columbia problem gambling prevalence

study. Victoria, BC: Author.

102. Brown, D., Patton, D., Dhaliwal, J., Pankratz, C., &

Broszeit, B. (2002). Gambling involvement and

problem gambling in Manitoba. Winnipeg, MB:

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103. Hodgins, D. (2006, April). What is the impact of

gambling availability on gambling problems? Paper

presented at the 5 th Annual Alberta Conference

on Gaming Research, Banff, AB.

104. O’Neil, M., & Whetton, S. (2004). Inquiry into the

management of electronic gaming numbers. (Economic

Issues No. 9). The South Australian Centre

for Economic Studies.

105. Marshall, D., McMillen, J., Niemeyer, S., & Doran,

B. (2004). Gaming machine accessibility and use

in suburban Canberra: A detailed analysis of the

Tuggeranong Valley. Australian National University

and the ACT Gambling and Racing Commission.

Canberra, Australia.

106. Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell,

M., & Parker, J. C. (2004). Risk factors for pathological

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335.

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107. The South Australian Centre for Economic Studies.

(2005). Study of the impact of caps on electronic

gaming machines – Final report. Office of gaming

and racing. Melbourne, Australia.

108. Marshall, D. (2005). The gambling environment and

gambler behaviour: Evidence from Richmond-

Tweed, Australia. International Gambling Studies,

5(1), 63-83.

109. McMillen, J., & Doran, B. (2006). Problem gambling

and gaming machine density: socio-spatial analysis

of three Victorian localities. International

Gambling Studies, 6(1), 5-29.

110. Gilliland, J. A., & Ross, N. A. (2005). Opportunities

for video lottery terminal gambling in Montréal:

An environmental analysis. Canadian Journal of

Public Health, 96(1),

55-59.

111. Wheeler, B. W., Rigby, J. E., & Huriwari, T. (2006).

Pokies and poverty: Problem gambling risk factor

geography in New Zealand, Health & Place,

12(1), 86-96.

112. Hinch, T., & Walker, G. (2003). Casino patrons, travel

behaviour, place attachment, and motivations: A

study of Alberta residents. Prepared for the Alberta

Gaming Research Institute.

113. Marshall, D., & Baker, R. G. (2001). Clubs, spades,

diamonds and disadvantage: the geography of

electronic gaming machines in Melbourne. Australian

Geographical Studies, 39(1), 17-33.

114. Wilson, D. H., Gilliland, J., Ross, N. A., Derevensky,

J., & Gupta, R. (2006). Video lottery terminal

access and gambling among high school students

in Montreal. Canadian Journal of Public Health,

97(3), 202-206.

115. Ministry of Health. (2006). Problem gambling geography

of New Zealand 2005. (Public Health Intelligence

Monitoring Report Number 7). Wellington,

New Zealand: Ministry of Health.

116. Quartile. (n.d.). Wikipedia, the free encyclopedia.

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117. Morgan, D. L. (1997). Focus groups as qualitative research

(2nd ed.). Thousand Oaks, CA: Sage.

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Electronic Gaming Machines and Problem Gambling

APPENDIX 1:

KEY INFORMANTS

A total of 69 Key Informants from across Canada and

abroad were asked to participate in this study. They included:

1) problem gambling Researchers, identified

through the published literature and/or personal referral;

2) gaming and problem gambling Specialists (i.e., health

and problem gambling professionals, regulators, operators,)

identified through gambling governing bodies and/or

personal referral; 3) problem gambling Counsellors, identified

through addiction agencies in Saskatchewan and

Ontario and/or personal referral; and 4) EGM Problem

Gamblers themselves, recruited through problem gambling

services in Saskatchewan and Ontario. The names of the

Key Informants asked to participate in the study are listed

below. xix

PROBLEM GAMBLING RESEARCHERS

Canadian

Pamela Collins, Project Co-coordinator, Dalhousie

Gambling Lab, Department of Psychology,

Dalhousie University.

Brian Cox, Professor, Departments of Psychiatry and

Psychology, University of Manitoba.

Shawn Currie, Researcher, Alberta Gaming Research

Institute.

Jeffrey Derevensky, Department of Educational and

Counselling Psychology, McGill University.

Harley Dickinson, Professor, Department of Sociology,

University of Saskatchewan.

Katharine Diskin, PhD Candidate, University of

xix In order to preserve anonymity and confidentiality, the names of the

Problem Gamblers who participated in this study are not reported here.

Calgary.

David Hodgins, Professor, Department of Psychology,

University of Calgary.

David Korn, Professor, Department of Public Health

Sciences, University of Toronto.

Robert Ladouceur, Professor, Department of

Psychology, Université Laval.

Tracy Schrans, Owner and Vice President, Focal

Research Consultants Ltd.

Garry Smith, Gambling Research Specialist, Alberta

Gaming Research Institute, Faculty of Extension,

University of Alberta.

Sherry Stewart, Professor, Department of Psychology,

Community Health and Epidemiology, Dalhousie

University.

Tony Toneatto, Research Scientist, Centre for Addiction

and Mental Health.

Nigel Turner, Research Scientist, Centre for Addiction

and Mental Health.

Jamie Wiebe, President, Factz Research.

Robert Williams, Professor, School of Health Sciences,

University of Lethbridge.

Harold Wynne, President, Wynne Resources.

American

Bo Bernhard, Assistant Professor of Sociology,

University of Nevada, Las Vegas.

Robert Breen, Associate Director, Rhode Island

Gambling Treatment Centre.

Mark Dixon, Associate Professor, Behavior Analysis and

Therapy program,

Rehabilitation Institute of Southern Illinois University.

Lia Nower, Assistant Professor of Social Welfare,

University of Missouri.

Rachel Volberg, President, Gemini Research Ltd.

Jeffrey Weatherly, Department Chair, Department of

Psychology, University of North Dakota.

Mark Zimmerman, Associate Professor, Department of

Psychiatry and Human Behavior, Brown University.

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Electronic Gaming Machines and Problem Gambling

International

Alex Blaszczynski, Professor, School of Psychology,

University of Sydney.

Peter Collins, Professor and Director, Centre for the

Study of Gambling, University of Salford.

Paul Delfabbro, Senior Lecturer, School of Psychology,

University of Adelaide.

Mark Dickerson, Professor, School of Psychology,

University of Western Sydney.

Nicki Dowling, School of Psychology, Psychiatry and

Psychological Medicine, Monash University.

Mark Griffiths, Professor, Division of Psychology,

Nottingham Trent University.

Nerilee Hing, Associate Professor, School of Tourism

and Hospitality Management, Southern Cross

University.

Charles Livingstone, Senior Research Fellow, Australian

Institute for Primary Care, LaTrobe University.

Jan McMillan, Professor, Centre for Gambling

Research, Australian National University.

Michael O’Neil, Director, The South Australian Centre

for Economic Studies.

Louise Sharpe, Senior Lecturer, Director of Clinical

Research, School of Psychology, University of Sydney.

Michael Walker, Senior Lecturer, School of Psychology,

University of Sydney.

SPECIALISTS

Health and Problem Gambling Professionals

Canadian

Steve Christensen, Program Consultant, Community

Care Branch, Saskatchewan Health.

Sharon Jackson, Problem Gambling Program Manager,

Walter Thorpe Recovery Centre.

Gerry Kolesar, Supervisor, Problem Gambling Services,

Addictions Foundation of Manitoba.

Kyle Prettyshield, Program Manager, First Nations

Addiction Rehabilitation Foundation (Saskatchewan).

Robert Simpson, Chief Executive Officer, Ontario

Problem Gambling Research Centre.

Bill Ursel, Director, Problem Gambling Unit, Canadian

Mental Health Association.

American

Keith Whyte, Executive Director, National Council on

Problem Gambling.

International

Mark Henley, Manager, Advocacy and Communication,

Uniting Care Wesley Adelaide.

Regulators

Canadian

Donna Klingspohn, Manager, British Columbia

Problem Gambling Program.

Elizabeth Stephenson, Director, Research &

Communications, Manitoba Gaming Control

Commission.

Kent Verlik, Director, Social Responsibility, Ministry of

Gaming (Alberta).

International

Linda Woo, Executive Director, Licensing and Gaming

Services, Queensland Office of Gaming Regulation.

Operators

International

Rob d’Hondt, Manager and Senior Trainer/Consultant,

d’Hondt Training & Consultancy, Hulst, The

Netherlands.

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Electronic Gaming Machines and Problem Gambling

PROBLEM GAMBLING COUNSELLORS

Saskatchewan

Cathy Dickson, Prince Albert Parkland Regional Health

Authority.

Don Ozga, Regional Health Authority, Regina

Qu’Appelle.

Barb Papp, Saskatoon Regional Health Authority.

Ontario

Evelyn Bakich, Sister Margaret Smith Centre.

Rachel Fraser, Addictions Assessment Services of

Ottawa-Carleton.

Janine Robinson, Centre for Addiction and Mental

Health Problem Gambling Service.

Lisa Root, Niagara Alcohol & Drug Assessment Service,

Gambling Support Services.

Randy Uyenaka, Pinewood Centre of Lakeridge Health.

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Electronic Gaming Machines and Problem Gambling

APPENDIX 2:

KEY INFORMANT

QUESTIONNAIRE

The Responsible Gambling Council (RGC) would like to learn more about the relationship between EGMs and problem gambling

from experts such as you. To assist us in this endeavor, we have developed the following questionnaire, which we hope

you will complete. We expect it should take no longer than one hour and would be most appreciative if you could return it to

us no later than July 7, 2006.

Unless you indicate otherwise, your responses to this questionnaire will be kept confidential. That is, your answers will be saved

on a secure server, only members of the RGC research team and the Saskatchewan Liquor and Gaming Authority (SLGA) will

have access to them, and your name will not be associated with your responses in any published reports. However, if you are

open to us citing your ideas directly in our final report, please check the appropriate box at the end of the questionnaire. This

will ensure that if we do include any of your quotes, they will be properly credited to you. Please note that while your answers

will not be associated with your name unless you check this box, we will include in the final report the names of experts we

consulted with for the purpose of this study.

We may want to follow up with you at a later date to explore further some of your opinions and ideas expressed in the survey.

If you are open to potentially being re-contacted, please check the appropriate box at the end of the questionnaire.

If you would like to see and print the questionnaire in its entirety before you begin, please click here.

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Electronic Gaming Machines and Problem Gambling

SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING

The following is a compilation of some of the key features of electronic gaming machines (EGMs i.e., slots and video lottery

terminals), venues, and accessibility factors said to contribute to problem gambling. In your opinion, using the 5-point scale

provided, please indicate the importance of each feature as a contributor to problem gambling.

In your opinion, how important are the following factors as contributors to EGMrelated

problem gambling?

Not at all

Important

Slightly

Important

Moderately

Important

Very

Important

Extremely

Important

EGM Features

Fast speed of play (e.g., shorter time between initial bet and outcome) 1 2 3 4 5

Sound effects (i.e., music, buzzing and ringing) 1 2 3 4 5

Visual effects (i.e., lights, colours) 1 2 3 4 5

Bill acceptors 1 2 3 4 5

Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 1 2 3 4 5

Direct electronic fund transfers at machine (e.g., direct debit) 1 2 3 4 5

Display machine activity in credits instead of cash 1 2 3 4 5

Payout in tickets instead of cash 1 2 3 4 5

Payout in tokens instead of cash 1 2 3 4 5

Large denomination maximum betting amounts (e.g., $5, $10) 1 2 3 4 5

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 1 2 3 4 5

Large denomination minimum betting amounts (e.g., $1, $5) 1 2 3 4 5

Large range between minimum and maximum betting amounts (e.g., 1¢ to $5) 1 2 3 4 5

Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines) 1 2 3 4 5

Prominent big prize advertising on machine 1 2 3 4 5

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 1 2 3 4 5

Type of games available on one machine (e.g., poker, video slots, keno) 1 2 3 4 5

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 1 2 3 4 5

Bonus round game features that reward players with further play on related game with different

features

1 2 3 4 5

Player controlled stop button 1 2 3 4 5

Display machine activity in credits instead of cash 1 2 3 4 5

Appearance of almost winning (i.e., near-miss) 1 2 3 4 5

Large mixture of small, medium, and large prize values, that increases the volatility of the game (i.e.

game is less predictable)

1 2 3 4 5

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Electronic Gaming Machines and Problem Gambling

In your opinion, how important are the following factors as contributors to EGMrelated

problem gambling?

Not at all

Important

Slightly

Important

Moderately

Important

Very

Important

Extremely

Important

EGM Features

Higher house advantage or edge (i.e., average amount per bet taken by gaming operator) 1 2 3 4 5

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 1 2 3 4 5

Offering winning outcomes more frequently through a higher “hit-rate” (i.e., higher chances of a win

occurring)

Offering winning outcomes less frequently through a lower “hit-rate” (i.e., lower chances of a win

occurring)

Offering small-win outcomes more frequently through a lower “hit-rate” (i.e., higher chances of a

small win occurring)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Wide variation in possible game outcomes (i.e., high outcome volatility) 1 2 3 4 5

EGM Venue Features

Large number of EGMs within venue 1 2 3 4 5

EGMs located in non-dedicated gaming venue (e.g., bar, hotel) 1 2 3 4 5

EGMs located in a dedicated gaming venue (e.g., EGM venue, racetrack) 1 2 3 4 5

Low visibility of the EGMs within the venue 1 2 3 4 5

No clocks in venue 1 2 3 4 5

No windows in venue 1 2 3 4 5

ATMs located on gaming floor or close to machines 1 2 3 4 5

ATMs located anywhere in the EGM venue 1 2 3 4 5

Frequent big prize advertising or promotion in the venue 1 2 3 4 5

Targeted player marketing for EGMs 1 2 3 4 5

General gambling marketing 1 2 3 4 5

Easy access to alcohol 1 2 3 4 5

24 hour access to EGMs in venue 1 2 3 4 5

Full access to EGMs for play in venue 1 2 3 4 5

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Electronic Gaming Machines and Problem Gambling

In your opinion, how important are the following factors as contributors to EGMrelated

problem gambling?

Not at all

important

Slightly

Important

Moderately

important

Very Important

Extremely

important

Community Accessibility Features

Large number of community venues (bars, lounges, EGM venues, other) with EGMs 1 2 3 4 5

Wide dispersion of EGMs throughout community 1 2 3 4 5

Convenient location of EGMs sites (e.g., close proximity to high residential populations) 1 2 3 4 5

Large total number of EGMs in community 1 2 3 4 5

Large number of EGMs per capita in community 1 2 3 4 5

Overconcentration of EGMs in low income neighbourhoods 1 2 3 4 5

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Electronic Gaming Machines and Problem Gambling

SECTION A: OPEN-ENDED QUESTIONS

Referring to Section A, please list the top three most important EGM features, EGM Venue features, and Community Accessibility

features that you think most likely contribute to problem gambling. For instance, if you think that sound effects are the

EGM feature that most likely contributes to problem gambling, indicate this as your first choice, and then please explain your

reasoning for your selection.

50) EGM Features

First

Second

Third

Please indicate any other EGM feature, not listed in Section A, that you think is an important contributor to problem gambling.

Please also explain your reasoning for specifying this additional feature.

51) EGM Venue Features

First

Second

Third

Please indicate any other EGM Venue feature, not listed in Section A, that you think is an important contributor to problem

gambling. Please also explain your reasoning for specifying this additional feature.

52) Community Accessibility Features

First

Second

Third

Please indicate any other Community Accessibility feature, not listed in Section A, that you think is an important contributor

to problem gambling. Please also explain your reasoning for specifying this additional feature.

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Electronic Gaming Machines and Problem Gambling

SECTION B: EGM/VENUE/ACCESSIBILITY MODIFICATIONS

It has been suggested that a number of modifications to EGMs, the venues that house them, and their overall accessibility in

the community may help reduce the risk of problem gambling. Using the 5-point scale provided, please indicate how effective

you think each modification would be in reducing this risk. Also, using the 3-point scale, please indicate your opinion of how

strong the evidence is to support the effectiveness of each modification in reducing this risk.

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how strong

is the evidence supporting

the effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately

effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM

Increasing time elapsed between

initial bet and outcome (e.g., 2.5 to

5 sec. reel spin)

Increasing time between the

outcome of one bet and the next

bet (i.e., slowing play)

Reducing volume of sound effects

(e.g., music and ringing)

Eliminating sound effects and

music

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Toning down lights and colours 1 2 3 4 5 1 2 3

Removing bill acceptors from

EGMs

Removing large bill acceptors

from EGMs (e.g., 20 or 50

denominations)

Eliminating electronic fund

transfers at the EGMs i.e., direct

debit

Delaying immediate access to

large wins (i.e., paying out large

wins in the form of cheques)

Paying out in cash instead of

tokens

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Paying out in cash instead of tickets 1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how strong

is the evidence supporting

the effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately

effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM

Reducing maximum bet size 1 2 3 4 5 1 2 3

Increasing minimum bet size 1 2 3 4 5 1 2 3

Reducing range between

minimum and maximum bet sizes

(e.g., 5¢-$1 versus 5¢-25¢)

Decreasing # of lines on which one

can bet (e.g., 5 to 3 lines)

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Eliminating advertising of big

prizes on machines

Eliminating frequent presentation

of big prize symbols shown during

play (e.g., reel placement)

Removing some types of games

from EGMs altogether (e.g., poker,

video slots, keno)

Decreasing game variety on a

machine

Eliminating bonus rounds (e.g.,

further play on a different game

with different features)

Removing player controlled stop

button

Showing only the relevant

outcome combinations

Hiding spinning reels from player’s

view

Displaying simultaneous

(as opposed to sequential)

presentation of reel outcomes

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how strong

is the evidence supporting

the effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately

effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM

Decreasing house advantage (i.e.,

average amount taken per bet by

gaming operator)

Increasing house advantage (i.e.,

average amount taken per bet by

gaming operator)

Decreasing the chances of a win

occurring (e.g., 25% to 5%)

Increasing the chances of a win

occurring (e.g., 8% to 30%)

Decreasing the chances of small

wins occurring

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Reducing game volatility 1 2 3 4 5 1 2 3

Displaying total time of play on

screen

1 2 3 4 5 1 2 3

Displaying time of day on screen 1 2 3 4 5 1 2 3

Providing an option to set personal

pre-determined time limits

Requiring players to set a predetermined

time limit

Adding countdown clock showing

time limit remaining

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Enforcing play stoppage, break or

interruption

1 2 3 4 5 1 2 3

Providing running cash totals of

amount spent on screen

1 2 3 4 5 1 2 3

Displaying machine activity in cash

value instead of credits

1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how strong

is the evidence supporting

the effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately

effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM

Providing an option to set personal

pre-determined spending limits

1 2 3 4 5 1 2 3

Requiring players to set predetermined

spending limits

1 2 3 4 5 1 2 3

Displaying responsible gambling

messages during play

Providing general information

about responsible gambling on

welcome screen

Providing on-screen Helpline

number and message

Providing Helpline number and

message on the back of printed

payout ticket

Adding responsible gaming

button leading to gambling

information screens

Requiring mandatory registration

and use of smart card to begin

play

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how

strong is the evidence

supporting the

effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM VENUE

Reducing the number of EGMs in

a facility

Capping the number of EGMs in

a facility

Providing non-gaming

entertainment on site

Restricting EGMs to dedicated

gaming venues (EGM site,

racetrack)

Placing EGMs in a highly visible

location in the facility

Displaying time of day in gaming

room

Providing windows in the gaming

room

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Removing ATMs from the EGM site 1 2 3 4 5 1 2 3

Removing ATMs from the EGM site

gaming floor

Restricting daily ATM withdrawal

amount

Allowing only one ATM withdrawal

per venue visit

Prohibiting access to funds from

credit cards at ATMs

Prohibiting the cashing of cheques

at venue

Prohibiting prize advertising at

gaming venue

Eliminating targeted player

marketing for EGMs

Reducing targeted player

marketing for EGMs

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

In your opinion, how effective would the

following modifications be in reducing the risk

EGM-related problem gambling?

In your opinion, how

strong is the evidence

supporting the

effectiveness of each

modification in reducing

problem gambling risk?

MODIFICATIONS

Not at all effective

Slightly effective

Moderately effective

Very effective

Extremely effective

Weak

Moderate

Strong

EGM VENUE

Eliminating general gambling

marketing

Reducing general gambling

marketing

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Prohibiting access to free alcohol 1 2 3 4 5 1 2 3

Prohibiting the service of alcohol

at the EGM

Prohibiting venues from being

open 24 hours/day

Restricting EGM play-time hours

in venue

Providing a self- exclusion

program

Establishing patron information &

education initiatives in venue

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

Conducting venue staff training 1 2 3 4 5 1 2 3

COMMUNITY ACCESSIBILITY

Reducing the number of EGM

facilities in a community

Capping the number of EGM

facilities in a community

Centralizing EGMs to one or a few

locations

Restricting EGMs to destination

style gaming facilities, away from

residential populations

Limiting concentration of EGMs in

low income neighbourhoods

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

1 2 3 4 5 1 2 3

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Electronic Gaming Machines and Problem Gambling

SECTION B: OPEN-ENDED QUESTIONS

Please list the top three modifications to EGMs, Venues, and Community Accessibility that you think would most likely

reduce problem gambling risk. For example, if you think that reducing speed of play is the most important EGM feature to

change, please indicate this as your first choice and then please explain your reasoning.

129) EGM Features

First

Second

Third

Please indicate any other EGM feature modification, not listed in Section B, that you think would most likely reduce EGMrelated

problem gambling risk. Please also explain your reasoning for specifying this additional feature modification.

130) Venue Features

First

Second

Third

Please indicate any other EGM venue modification, not listed in Section B, that you think would most likely reduce EGM-related

problem gambling risk. Please also explain your reasoning for specifying this additional venue modification.

131) Community Accessibility Features

First

Second

Third

Please indicate any other EGM accessibility modification, not listed in Section B, that you think would most likely reduce

EGM-related problem gambling risk. Please also explain your reasoning for specifying this additional modification.

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Electronic Gaming Machines and Problem Gambling

Venue Specific Harm Minimization Strategies

In the space provided below, please describe your thoughts regarding any improvements you might make to the self-exclusion

program, patron information and education initiatives, and staff training programs. For example, you may want to describe

why you do not think that the advertising of the self-exclusion program is effective and what you would suggest to make

changes.

132) Self-exclusion program

133) Patron information and education initiatives

134) Staff training

135) Please indicate any other harm minimization strategy that you think would most likely reduce EGM-related problem

gambling risk. Please also explain your reasoning for specifying this strategy.

136) Please indicate your general area of expertise

Health and Problem Gambling Specialist CDN INT

Problem Gambling Researcher CDN INT

Regulator CDN INT

Operator CDN INT

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Electronic Gaming Machines and Problem Gambling

APPENDIX 3:

OPEN-ENDED RESPONSES

TO QUESTIONNAIRE

Key Informants who participated in this study (i.e., Researchers,

Specialists, Counsellors, and EGM Problem Gamblers)

were asked to complete a comprehensive questionnaire

regarding EGM-related problem gambling (Appendix

2). As part of the questionnaire, some Key Informants (i.e.,

Researchers and Specialists) were asked to answer supplemental,

open-ended questions about the factors that could

either contribute to, or minimize, problem gambling. Topics

explored in these open-ended questions relevant to the present

report include:

• Additional features that might contribute to

problem gambling not already mentioned in

the questionnaire (i.e., EGM features, venue

features, community accessibility features),

and

• Additional modifications to the above features

that might reduce problem gambling

risk not already mentioned in the questionnaire.

The responses given by the Researchers (N = 13) and Specialists

(N = 12) to the open-ended portion of the questionnaire

are presented below.

Additional EGM Features That Contribute to

Problem Gambling

- Sound/visual effects tested on-site in venues, rather than

in laboratories Rxx

- Continuous play R

- Linked jackpots can encourage a ‘feeding frenzy’ when

thought close to a payout level R

- ‘Free spin’ features on Australian-style EGMs appear to be

strongly related to play patterns of problem gamblers R

- Features encouraging players to bet more, such as ‘buy’

features/bonuses, could lead players to increase bet size

especially if the option is presented during a game S

- Overall issue of game design, mapping, and display reels

needs to be evaluated closely by government regulators S

- Pop-up messages, the ability of players to set their own

time and money limits, machine setting time limits,

tracking spending/losses, easy access to on screen problem

gambling/responsible choice messages, information

about cost per hour S

Additional Venue Features That Contribute to Problem

Gambling

- Gambling areas that can be accessed directly from car

parks and the street, as players can then access gambling

in secret S

- EGMs secluded in quiet corners of gaming establishments

limit interaction with others including staff S

- Venues with EGMs as a major facility, i.e., venues that

generate a high proportion of income from EGMs versus

other entertainment facilities and recreational options R

- Promotions that require the patron to wait a long time

in the venue before winners are announced encourages

longer gambling sessions R

Additional Community Accessibility Features That

Contribute to Problem Gambling

- Over-concentration of EGM in low income neighbourhoods

may be undesirable as this needs to be balanced

against the fact that low income earners may have limited

opportunities for social interaction and having entertainment

facilities located in their neighbourhood may

be positive for that community S

- Traditionally government would be responsible for

regulation, enforcement and consumer protection.

However, in most jurisdictions that have allowed EGMs,

the governments have either become the operator, promoter,

and a major beneficiary of gaming operations.

This appears to have compromised their previous roles.

The government promotion and sanctioning of gaming

has led to an increase in gaming activities that perhaps

would not have been there had the government taken

a more enforcement role and a more public safety approach.

S

xx R = Researchers; S = Specialists

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Electronic Gaming Machines and Problem Gambling

- ‘Fit’ between communities and accessibility to EGMs. We

have evidence that some communities are more resilient

than others, with greater capacity to minimise gambling

harm. Conventional socio-demographic-economic indicators

are not predictors. R

- Free buses to gambling venues which increase access R

- There is not terribly strong evidence that problem gambling

is more so an issue for low income individuals.

Stats I am familiar with note moderate to higher income

persons with problem gambling behaviour. S

Additional EGM Modifications to Reduce Problem

Gambling

- Control over loss limits by calibrating the central system

so that players could lose no more than $50 in a 48 hour

period R

- Modifications to make the game unappealing, e.g., an

inter-trial interval of greater than 15 seconds (average

reel spin speed 3.5 - 5.0 seconds; players play at a rate of

one spin per 10 seconds) R

- Some of the feature modifications identified in this survey

have interactions, e.g., increasing speed of play by

itself may have minimal effect if number of lines and

bet levels are kept at existing levels. However, if they are

raised at the same time, the combination could lead to

problematic behaviours S

- Remove or restrict linked jackpots R

- Elimination of free spin features R

- Photo-recognition imbedded in machines to enforce

voluntary self-exclusion S

Additional Venue Modifications to Reduce Problem

Gambling

I-care system, which is a responsible gaming tracking

system based on player wagering behaviour. This system

which is transferable to all EGM systems and venues, if

combined with a smart card system, would appear to be

a highly effective system in reducing risks S

- Reducing ATM access might have unpredictable results.

It might cause people to access more money ahead

of time because they know they can’t access it at the

casino R

- Eliminating targeted advertisements is a bit of a problem

because it would be possible to avoid marketing to problem

players S

Additional Community Accessibility Modifications to

Reduce Problem Gambling

- The issue of accessibility will differ from community to

community and it is necessary to understand the dynamics

of individual communities to be truly effective. S

- If the emphasis is on prevention I think you need to

provide information and messaging outside of gaming

venues. By the time people have decided to play they

are not interested in RG or PG messages. Don’t confuse

responsible gambling messages with problem gambling

messages. Give people some guidelines by which to assess

their play. Work done by David Hodgins is very interesting

in this regard. Work on early education with

youth about dangers of over gambling. S

- Prohibition may be worth thinking about - particularly

if there are numerous other less risky gambling options

available. EGMs are clearly the most dangerous gambling

mode! R

- reducing the number of EGMs in a community S

- Gaming areas should be fully integrated into the facility

and located prominently in venues so gamblers cannot

hide away and gamble in secret S

- No credit or cheque-cashing privileges R

- Using smart cards with pre-set limits and no play until

debt is paid S

- Encourage operators to be receptive and involved in

player information/protection measures. Setting an example

at the top makes it easier for employees to embrace

and implement soft intervention techniques. This

could be accomplished via regulatory intervention if operators

are not receptive. S

- Saskatchewan Gaming Corporation has developed the

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Electronic Gaming Machines and Problem Gambling

APPENDIX 4: COMPLETE

RANKINGS OF CONTRIBUTORS

AND MODIFICATIONS

TABLE A1. Rank Order of Mean Importance Scores: EGM Contributors (Researchers and Specialists)

EGM Contributor

Researchers

Item Rank Order

Specialists

Fast speed of play (e.g., shorter time between initial bet and outcome) 1 3

Direct electronic fund transfers at machine (e.g., direct debit) 2 1

Appearance of almost winning (i.e., near-miss) 3 2

Bill acceptors 4 4.5

Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 6 7

Player controlled stop button 6 7

Large mixture of small, medium, and large prize values, that increases the volatility of the game (i.e. game is

less predictable)

6 15

Prominent big prize advertising on machine 8 15

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 9.5 4.5

Bonus round game features that reward players with further play on related game with different features 9.5 11

Large denomination minimum betting amounts (e.g., $1, $5) 11 9

Large denomination maximum betting amounts (e.g., $5, $10) 12 7

Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines) 13.5 11

Display machine activity in credits instead of cash 13.5 18.5

Wide variation in possible game outcomes (i.e., high outcome volatility) 15 15

Offering winning outcomes more frequently through a higher “hit-rate” (i.e., higher chances of a win

occurring)

16 11

Large range between minimum and maximum betting amounts (e.g., 1¢ to $5) 17.5 13

Sound effects (i.e., music, buzzing and ringing) 17.5 24

Visual effects (i.e., lights, colours) 19.5 21

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 19.5 26

Payout in tickets instead of cash 21.5 17

Type of games available on one machine (e.g., poker, video slots, keno) 21.5 24

Payout in tokens instead of cash 23.5 18.5

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 23.5 27

Higher house advantage or edge (i.e., average amount per bet taken by gaming operator) 26 20

Offering winning outcomes less frequently through a lower “hit-rate” (i.e., lower chances of a win occurring) 26 22

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 26 24

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Electronic Gaming Machines and Problem Gambling

TABLE A2. Rank Order of Mean Importance Scores: Venue Contributors (Researchers and Specialists)

Venue Contributor

Researchers

Item Rank Order

Specialists

ATMs located on gaming floor or close to machines 1.5 1

24 hour access to EGMs in venue 1.5 3

Targeted player marketing for EGMs 3.5 2

EGMs located in non-dedicated gaming venue (e.g., bar, hotel) 3.5 4

ATMs located anywhere in the EGM venue 5.5 5

Easy access to alcohol 5.5 8

Full access to EGMs for play in venue 7 6.5

Frequent big prize advertising or promotion in the venue 8 6.5

Large number of EGMs within venue 9 11

General gambling marketing 10 9

EGMs located in a dedicated gaming venue (e.g., casino, racetrack) 11 10

No windows in venue 12 13

Low visibility of the EGMs within the venue 13 12

No clocks in venue 14 14

TABLE A3. Rank Order of Mean Importance Scores: Community Accessibility Contributors

(Researchers and Specialists)

Community Accessibility Contributor

Researchers

Item Rank Order

Specialists

Large number of community venues (bars, lounges, casinos, other) with EGMs 1 2

Wide dispersion of EGMs throughout community 3 1

Convenient location of EGMs sites (e.g., close proximity to high residential populations) 3 3

Overconcentration of EGMs in low income neighbourhoods 3 6

Large number of EGMs per capita in community 5 4

Large total number of EGMs in community 6 5

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Electronic Gaming Machines and Problem Gambling

TABLE A4. Rank Order of Mean Effectiveness Scores: EGM Modifications by Key Informant Group

EGM Modification

Eliminating electronic fund transfers at the EGMs i.e.,

direct debit

Item Rank Order by Key Informant Group

Researchers Specialists Counsellors

Problem

Gamblers

1 2 5 1

Removing bill acceptors from EGMs 2 4 14.5 9

Removing large bill acceptors from EGMs (e.g., 20 or

50 denominations)

Require mandatory registration and use of smart card

to begin play

Requiring players to set pre-determined spending

limits

3.5 1 1 2

3.5 7 14.5 16

5 3 2.5 7

Requiring players to set a pre-determined time limit 6.5 5.5 5 6

Providing running cash totals of amount spent on

screen

Providing an option to set personal pre-determined

time limits

Providing an option to set personal pre-determined

spending limits

Increasing time elapsed between initial bet and

outcome (e.g., 2.5 to 5 sec. reel spin)

6.5 5.5 10.5 12

8.5 8.5 2.5 5

8.5 12 10.5 21.5

11.5 12 5 4

Reducing maximum bet size 11.5 18 19.5 9

Eliminating bonus rounds (e.g., further play on a

different game with different features)

11.5 17 36.5 21.5

Enforcing play stoppage, break or interruption 11.5 10 27 23.5

Displaying machine activity in cash value instead of

credits

Delaying immediate access to large wins (i.e., paying

out large wins in the form of cheques)

14 14.5 10.5 9

15 24 10.5 3

Hiding spinning reels from player’s view 16 16 19.5 23.5

Removing player controlled stop button 17 8.5 19.5 27.5

Displaying total time of play on screen 18 19.5 7.5 17.5

Eliminating advertising of big prizes on machines 19 27 27 12

Decreasing the chances of small wins occurring 20 25.5 14.5 35

Decreasing # of lines on which one can bet (e.g., 5 to

3 lines)

21 23 24 14.5

Eliminating sound effects and music 22.5 28.5 27 14.5

Decreasing the chances of a win occurring (e.g., 25%

to 5%)

22.5 30 34 20

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Electronic Gaming Machines and Problem Gambling

(Table A4 continued from previous page)

EGM Modification

Item Rank Order by Key Informant Group

Researchers Specialists Counsellors

Problem

Gamblers

Toning down lights and colours 25 33 27 12

Increasing the chances of a win occurring (e.g., 8% to

30%)

25 25.5 7.5 19

Displaying time of day on screen 25 34 40 37

Reducing volume of sound effects (e.g., music and

ringing)

27.5 28.5 32.5 27.5

Provide on-screen Helpline number and message 27.5 14.5 19.5 29

Paying out in cash instead of tickets 30.5 31.5 23 17.5

Add countdown clock showing time limit remaining 30.5 12 14.5 25.5

Displaying responsible gambling messages during

play

Add responsible gaming button leading to gambling

information screens

30.5 21.5 27 33

30.5 39.5 36.5 37

Paying out in cash instead of tokens 34.5 19.5 27 25.5

Removing some types of games from EGMs

altogether (e.g., poker, video slots, keno)

34.5 36.5 32.5 30

Decreasing game variety on a machine 34.5 36.5 19.5 31

Provide general information about responsible

gambling on welcome screen

Decreasing house advantage (i.e., average amount

taken per bet by gaming operator)

Provide Helpline number and message on the back of

printed payout ticket

34.5 38 39 37

37.5 33 36.5 34

37.5 21.5 27 39

Increasing minimum bet size 39 39.5 36.5 40

Increasing house advantage (i.e., average amount

taken per bet by gaming operator)

40 31.5 19.5 32

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Electronic Gaming Machines and Problem Gambling

TABLE A5. Rank Order of Mean Effectiveness Scores Venue Modifications by Key Informant Group

Venue Modification

Item Rank Order by Key Informant Group

Researchers Specialists Counsellors

Problem

Gamblers

Prohibiting access to funds from credit cards at ATMs 1 1 3 5

Removing ATMs from the casino gaming floor 2.5 2.5 10 1

Prohibiting the cashing of cheques at venue 2.5 2.5 10 6

Removing ATMs from the casino 4 4.5 6.5 4

Prohibiting access to free alcohol 5.5 8 12.5 8

Prohibiting the service of alcohol at the EGM 5.5 14 12.5 12.5

Restricting EGMs to dedicated gaming venues

(casino, racetrack)

7 12 3 18.5

Restricting daily ATM withdrawal amount 8 9 3 2.5

Allowing only one ATM withdrawal per venue visit 9 10.5 5 2.5

Prohibiting venues from being open 24 hours/day 10 10.5 6.5 7

Prohibiting prize advertising at gaming venue 11 18 17 10

Reducing the number of EGMs in a facility 12.5 6.5 8 12.5

Conducting venue staff training 12.5 19.5 17 14

Capping the number of EGMs in a facility 14.5 19.5 17 11

Providing a self-exclusion program 14.5 4.5 1 17

Establishing patron information & education

initiatives in venue

16 6.5 10 9

Place EGMs in a highly visible location in the facility 17 13 14 20

Providing windows in the gaming room 18 16.5 17 16

Providing non-gaming entertainment on site 19 15 20 18.5

Displaying time of day in gaming room 20 16.5 17 15

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Electronic Gaming Machines and Problem Gambling

APPENDIX 5:

FOCUS GROUP SCRIPT

Two focus groups with EGM problem gamblers were conducted

for this study: One in Regina, Saskatchewan (N = 4),

the other in Ajax, Ontario (N = 8). A description of the focus

groups’ methodology and results are presented in Chapter 3.

Below is the script that was used by the moderator to guide

the focus group discussions.

INTRODUCTION

Thank you very much for agreeing to participate in this study.

Your input will be of great value to the research. The purpose

of the focus group is to get your opinion on problem gambling

and electronic gaming machines. By electronic gaming

machines, I mean slot machines and VLTs. During the focus

group, you will be asked to give your opinion on different

issues related to EGMs, the venues that offer them, and the

machines’ accessibility in the community overall. You’ll also

be asked to give your opinion on what you think it is about

these things that increase the risk of problem gambling, and

what you think might help reduce this risk. The focus group

should take no more than one and a half hours. When providing

your answers during the focus group, please try to be

as open, frank, and detailed as you can.

WARM UP QUESTIONS

1. Can you tell me a bit about your gambling history?

a. How long have you been gambling?

b. Why did you start gambling?

c. How long were you playing EGMs before you felt

that you had developed a problem?

d.. When you first started gambling, what form of

gambling did you do?

e. Are you currently gambling?

MAIN QUESTIONS

2. Can you tell me a bit about your experience with VLTs

and slot machines?

a. Why are you drawn to these machines over other

forms of gambling? What is it about the machines

that appeals to you?

b. What is it about VLTs and slot machines that make

them so problematic? Why do you think this? For

example, some people think that their speed of

play is problematic.

c. If you could change anything about VLTs or slot

machines to make them less problematic, what

would you change?

d. Do you think that VLTs and slot machines are

more problematic than other forms of gambling?

If so, how would you describe the difference?

3. Can you tell me about the gaming venues you’ve attended?

a. Why are you drawn to them? What is it about the

venues that make gambling more appealing to

you?

b. Is there anything about the gaming venue that

makes gambling more of a problem for you? If so,

what is it? For example, some people think that

having a large number of EGMs at a site plays a

large role.

c. If you could change anything about the gaming

site to make gambling less of a problem for you,

what would you change and how would you do

this?

4. Can you tell me a bit about the availability of VLTs

and slot machines in the community?

a. How do you think the availability of the machines

affects your gambling? Why do you think this? For

example, some people believe that having VLTs

and slot machines located close to residential areas

can be a problem.


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Electronic Gaming Machines and Problem Gambling

b. If you could change anything about the availability

of VLTs or slot machines in your community,

what would you change?

5. What do you think gaming venues could do to effectively

address EGM-related problem gambling?

6. What is the one thing that you think would be most

effective in reducing the risk of EGM-related problem

gambling?

7. Have you ever self-excluded from a gaming venue?

a. Describe the effectiveness of the program. Can

you identify any successes you’ve had or challenges

that you’ve faced?

b. Overall, did it help you address

your gambling problems?


8. When you first started using VLTs or slot machines,

did you know about the risk of problem gambling?

9. Do you feel that if you had been aware of risk, it

would have reduced the likelihood of you developing

gambling-related problems?

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Electronic Gaming Machines and Problem Gambling

APPENDIX 6:

COUNSELLOR

INTERVIEWS

METHODOLOGY

Eight problem gambling counsellors from addiction agencies

participated in interviews for this study: five from

Saskatchewan, three from Ontario. Interviews were conducted

in-person or over the telephone by Dr. Jamie Wiebe

and lasted approximately one hour. Some of the topics covered

during the interviews of relevance to the present report

include:

• Counselling experience and clientele,

• Perceived EGM features, EGM venue features,

and community accessibility features that

contribute to problem gambling,

• Perceived modifications to the above features

that might reduce EGM-related problem

gambling risk, and

• Prevention strategies.

The script that was used by the interviewer to guide the interviews

is presented in Appendix 7. The names of the counsellors

who participated in the interviews are presented in

Appendix 1.

RESULTS

Counselling Experience and Clientele

Counsellors had been involved in addictions counselling in

general for 7 to 32 years, and problem gambling counselling

in particular for 2 to 12 years. All were currently providing

problem gambling counselling exclusively. All counsellors

said that the large majority of their clients had problems related

to EGMs, with five counsellors indicating that at least

80% of their clients had such problems. All but one counsellor

felt that the proportion of clients with EGM-related problems

had stayed stable over the years; the remaining counsellor

felt that the proportion of clients with EGM-related

problems had increased.

EGM Features That Contribute to Problem Gambling

Many counsellors said that the fast and continuous speed of

play of EGMs, coupled with their sights and sounds (which

create a “numbing or intoxicating effect”) contribute to EGMrelated

problems. Some mentioned the machines’ varied

schedule of reinforcement, which makes people more likely

to chase losses because they believe a win is more likely to occur.

Also mentioned was increased betting lines, which give

the perception that there is a greater chance of winning (with

“people getting betting tolerance”). The machines’ graphics,

interactive touch screen, and bonus rounds were also mentioned

as contributors. Finally, some counsellors said that

their clients were attracted to the machines’ ease of play, and

the lack of social interaction required.

Venue Features That Contribute to Problem Gambling

Most counsellors felt that access to cash through automated

teller machines (ATMs) in the gaming venue made it too

easy for people to exceed limits and spend additional money.

Some talked about the customer-service focus, in that players

are called by name and made to feel important. Others

described the comfort and safety element, that there are no

set rules with EGM play—players can choose to interact or

be autonomous. One counsellor felt that the spacing of machines

was a factor, noting that clients tend to have a preference

for where they want to play. Another felt that venue staff

increase beliefs that machines are due for a win by making

comments on which machines have, and have not, paid out

recently.

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Community Accessibility Features That Contribute to

Problem Gambling

All counsellors felt strongly that increased accessibility to

EGMs in the community increased problems, stating that

most of their clients would not have problems if the machines

were not in their community. In describing her clients,

one counsellor noted, “many clients talk about developing

problems by happenchance. They went to have a drink and

the machines were there.” Others talked about the problem

of having access to EGMs in small communities, where there

are few socializing and entertainment options.

EGM Modifications to Reduce Problem Gambling

A frequent suggestion to reduce EGM problem gambling

related to the machines themselves was to have smart cards

which include maximum spending limits or allow players

to set their own limit. One counsellor noted, “Clients often

say that they start with a limit but that they don’t stick to it.

A preset limit would work for some.” The counsellors from

Saskatchewan specifically noted the need for a card that applied

to both casinos and VLT sites. Another common suggestion

was to display machine activity in dollars or cents,

rather than in credits, that it is easier to devalue the amount

being spent and to lose track of expenditures with the latter.

To help reduce the amount of money spent, a few counsellors

recommended reducing maximum bets, number of betting

lines, and near misses (which increase the belief that a win

is imminent).

Many counsellors noted that there were minimal changes that

could be done to EGMs to assist their clients. As one counsellor

noted, “People with problems will play the machines no

matter how much they can bet.” Some counsellors felt that

pop-up messages that inform players of the amount of time

and money they have spent are a nuisance; two counsellors

described players with problems as being in the “zone,” such

that it is easy for them to disconnect from pop-up messages.

Slowing down machines was not viewed as an effective measure,

with one participant stating “you would have to slow it

down so much that it is not an option.”

Venue Modifications to Reduce Problem Gambling

this change. One counsellor described the issue as follows:

“If we consider this an impulse control disorder, then the

more time that you can put between the impulses, the better…the

more time to have a sober second thought.” Some

felt that more could be done to intervene with the gambler at

the gaming venue by encouraging players to take a break or

by approaching those who are visibly upset. One counsellor

felt that an intervention would be helpful if the person was

contemplative, but that it would annoy those who were precontemplative.

A few felt that players should not be allowed

to save machines, that some get attached to particular ones

and will save them if they need to go away for some reason

(e.g., to obtain more money). Some counsellors felt that a

“no save” rule would reduce the amount of time spent gambling.

A number of participants recommended that venues

provide information on the odds of winning, how the games

work, cost of playing, return rates, and the likelihood of winning

large prizes. As one participant explained, “People don’t

understand how the machines work. They believe that their

odds of winning are higher. They don’t realize that the majority

of prizes are small. They don’t understand the slippery

slope of not winning over time. They believe that some skill

is involved.” One counsellor suggested that this information

be made available to all players when signing up for a player’s

card.

There were several venue modifications that counsellors believed

would not affect problem gambling risk. Most, for instance,

felt that changing the hours of operation of a gaming

venue would not have an impact. As one participant stated,

“They tend to set a time when they gamble. It’s not about time

but about loss of control.” Reducing the number of machines

at a venue was also seen by some as ineffective, as it “would

have to be so pronounced and only make a difference if machines

are fully utilized all the time and this is not the case.”

Others noted that those with problems will wait in line for

a machine. Serving alcohol wasn’t seen as making much of

a difference, “for most clients, it is not about the alcohol.”

Banning prize ads was not viewed as having an impact because

clients know all about the prizes. Finally, although providing

information about the signs of a gambling problem

was not seen as impacting those with problems, many noted

that it may be important for preventing problems.

The most commonly suggested venue modification to reduce

EGM-related problem gambling was to remove ATMs from

gaming venues, with many noting that their clients wanted

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Community Accessibility Modifications to Reduce

Problem Gambling

All participants recommended the removal of VLTs

(Saskatchewan) and EGMs in residential areas (Ontario).

Overall, participants felt that EGMs should only be available

in gambling destination facilities.

- Decrease government involvement: A couple of respondents

felt that government should not be in the

gambling business; that it sends mixed messages and

facilitates the belief that gambling must be safe.

- Increase non-gambling options: Have more social alternatives

so that people don’t view gambling as the

only option for socializing and excitement.

Prevention Strategies

All of the counsellors felt that it is very difficult to reach those

who already have gambling-related problems, but that things

could be done to prevent problems from developing in the

first place. Suggestions of how best to prevent problems were

quite varied and included the following:

- Decrease access to EGMs: Remove VLTs from bars

and restaurants; remove EGMs from residential

areas.

- Decrease access to money: Remove ATMs from gaming

venues.

- Increase control over money spent: Provide smart

cards that specify maximum amounts that can be

spent; decrease maximum bets.

- Increase honesty and transparency: Inform consumers

of the risks, expected losses per hour, and odds

of winning; display machine activity in dollars or

cents rather than credits.

- Reduce gambling advertising: Many called for a reduction

in gambling advertising, with one participant

stating that the “product is marketed to a

point where we think that gambling circumvents

problems.”

- Raise public awareness of the problems associated

with gambling: One participant noted that it is still

“not okay to talk about problem gambling publicly.

People suffer alone. Society needs more normalizing

that problems do occur.” Another felt that it is

important to let people know that gambling can be

controlled, that you don’t have to quit in order to

get help.

- Intervene early: Provide on-site professionals who

can approach players displaying distress or who

have been gambling for extended periods of time.

- Target youth: Participants noted the importance of

early education and informing youth of the risks associated

with gambling before they reach legal age.

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APPENDIX 7:

COUNSELLOR

INTERVIEW SCRIPT

2. Can you tell me about your clientele?

a. What proportion of your clientele present with

gambling problems?

b. What proportion of this group are EGM users?

c. Has the proportion of EGM users changed over

time, if so, has it increased or decreased? How do

you account for the change?

MAIN QUESTIONS

Based on your experience and what you have learned

through counselling problem gamblers…

INTRODUCTION

Thank you very much for agreeing to participate in this study.

Your input will be of great value to the research. The purpose

of the interview is to get your opinion, as a counsellor working

in the field, on the relationship between electronic gaming

machines and problem gambling. As you know, by electronic

gaming machines, I mean slot machines and VLTs. During the

interview, you will be asked to give your opinion on different

issues related to EGMs, the venues that offer them, and the

machines’ accessibility in the community overall. You’ll also

be asked what you think it is about these things that increase

the risk of problem gambling, and what you think might help

reduce this risk.

When providing your answers during the interview, please try

to be as open, frank, and detailed as you can. I anticipate that

the interview will last about one hour. Before we begin, I just

want to inform you that by participating in the interview, you

are consenting to be involved in the research. Is that alright?

Great, let’s begin.

WARM UP QUESTIONS

1. Can you tell me a bit about your background as an addictions

counsellor?

a. How long have you been an addictions counsellor?

b. How long have you specialized in problem

gambling?

c. Is your counselling practice exclusively for problem

gambling?

3. Can you tell me a bit about EGMs?

a. What is it about the machines that make them

problematic? Why do you think this? For example,

some people think that their speed of play is a

problem. >

b. If you could change anything about EGMs to make

them less problematic for your clients, what would

you change and how would you do this?

c. Do you think that EGMs are more problematic

than other forms of gambling, such as casino table

games? If so, what makes you think this?

d. Do you think your clients would share these views

with you?

4. Can you tell me a bit about the gambling venue (i.e.,

casino, bars with EGMs)?

a. Is there anything about the venue that makes gambling

more of a problem for your clients? If so, what?

For example, some people think that having a large

number of EGMs at a site plays a large role. >

b. If you could change anything about the gaming site

to make gambling less of a problem for your clients,

what would you change and how would you

do this?

c. Do you think your clients would share these views

with you?

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Electronic Gaming Machines and Problem Gambling

5. Can you tell me a bit about the availability of EGMs in

the community?

a. How do you think the availability of EGMs in your

community plays a role in problem gambling for

your clients? Why do you think this? For example,

some people believe that having EGMs located

close to residential areas is problematic.

>

b. If you could change anything about the availability

of EGMs in your community, what would you

change?

c. Do you think your clients would share this view

with you?

6. What do you think is the best thing a gaming venue

could do to effectively address EGM-related problem

gambling?

a. What do you think is the BEST thing a gaming venue

can do?

7. What are your thoughts on the role that self-exclusion

plays in helping people with their gambling problems?

a. In your experience, has this type of program helped

your clients? If so, how?

b. Can you think of any benefits and/or limitations to

the self-exclusion program?

c. What do you think your clients would say about

the usefulness of self-exclusion as a way to recover

from problem gambling?

8. Do you think that if your clients had been aware of the

increased risk of problem gambling related to EGMs,

it would have reduced their likelihood of developing

problems?

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