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

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 prepa-ration of the report, and Jamie Wiebe, PhD, of Factz Research, for con-ducting and analyzing the focus groups and interviews.

The Responsible Gambling Council (RGC) is an independent, non-profit or-ganization 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 re-search and information dissemination.

www.responsiblegambling.org

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

TABLE OF CONTENTS

LIST OF TABLESTABLE 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

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Electronic Gaming Machines and Problem Gambling

EXECUTIVE SUMMARY

BACKGROUNDIn February 2006, the Saskatchewan Liquor and Gaming Authority (SLGA), the organization which regulates all video lottery terminals (VLTs) and slot machines, made a commit-ment to review its policies regarding electronic gaming ma-chines (EGMs) and problem gambling. To inform their re-view, SLGA asked the Responsible Gambling Council (RGC) to conduct a broad-based exploration of Key Informant opin-ions regarding best practices in the management of EGMs. As a non-profit organization whose mandate includes inves-tigation 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 gam-bling engaged in among individuals seeking treatment for problem gambling. However, EGMs are among the most ac-cessible 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 prob-lem 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 oth-er 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 gam-bling are strongly related.

Numerous studies have attempted to shed light on the na-ture of the relationship between EGMs and problem gam-bling. 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 �) 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 prob-lem 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 REVIEWThere 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 ma-chine’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 op-tions (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 EGM-based 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.

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KEY INFORMANT QUESTIONNAIREKey Informants from Canada and abroad were invited to complete a questionnaire on EGM-related problem gambling. Informants consisted of problem gambling Researchers, iden-tified through the published literature and/or personal refer-ral; gaming and problem gambling Specialists (i.e., health and problem gambling professionals, regulators, opera-tors), 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 prob-lem 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 over-all community accessibility features as contributors to prob-lem 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 reduc-ing 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 GROUPSTwo 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.

DISCUSSIONIn reviewing the literature and synthesizing the opinions of a cross-section of Key Informants for the present study, a num-ber of findings emerged which identified potential EGM-re-lated contributors to problem gambling, as well as possible modifications to reduce problem gambling risk.

EGM Features that Contribute to Problem GamblingWith 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 di-rectly while sitting at an EGM), the appearance of near-miss-es, and bill acceptors as the most important contributors to problem gambling. The importance of these items was sup-ported by a thematic analysis which showed that features that speed up play (e.g., short time intervals between bet and out-come), 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 GamblingConsistent with the finding that Key Informants identified direct electronic fund transfers and bill acceptors at EGMs as among the most important contributors to problem gam-bling, 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) mandato-ry setting of pre-determined spending limits, and on-screen running cash totals of the amount spent during an EGM ses-sion. 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 va-riety of features such as card-based access controls, player-controlled 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 reduc-ing the potential for overspending. Overall, Key Informants were more supportive of modifications to spending and ac-

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cess to funds, rather than in modifications that might damp-en the emotional experience and excitement of playing on EGMs.

Venue Features that Contribute to Problem GamblingAccording to the Researchers and Specialists in this study, the most important venue-related contributors to problem gam-bling were having ATMs located either on the gaming floor or close to machines, 2�-hour access to EGMs, and market-ing 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 GamblingThe 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, dis-allowing 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 GamblingOverall, 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 GamblingRegarding modifications to community accessibility fea-tures, 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 modifica-tion. However, the Key Informants as a group agreed that re-ducing 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 acces-sibility modifications.

SUMMARY & CONCLUSIONSIn a broad sense, Key Informants believed that certain fea-tures intrinsic to EGMs, such as the speed of play and ap-pearance 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 MoneyThe 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 dis-play of money, access to money through ATMs, cheque-cash-ing, direct electronic fund transfers, and the setting of spend-ing 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 prob-lem gambling.

Pre-commitmentPre-commitment constitutes the creation of pre-set spending or time limits that are established prior to the start of a gam-bling 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 TechnologyThe 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 pro-vide 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 univer-sal registration system and a requirement to have a card for machine access. Given that smart card systems can vary sig-nificantly in nature (e.g., by their time and money spending

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limits, optional/mandatory features, types and levels of en-forcement), Key Informants would likely have varying views on the breadth and comprehensiveness of such systems.

Restricting Community AccessIn terms of community accessibility, although there was relatively strong support for all the modifications examined, the study seemed to suggest that the Key informants over-all 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 ObservationsAmong the Key Informants, Researchers and Specialists were asked to assess the strength of evidence for each EGM, ven-ue, and community accessibility modification item. Overall, there were low levels of confidence in the strength of the cur-rent 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.

Implications and Future DirectionsThe literature reviewed for this study demonstrated that the current knowledge base regarding ways to reduce EGM-relat-

ed problem gambling is limited and incomplete. Most work-ing 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 infor-mation 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.

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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 commit-ment to review its policies regarding electronic gaming ma-chines (EGMs) and problem gambling.i To inform their re-view, 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 inves-tigation 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.

BACKGROUNDControversy and debate have surrounded EGMs for the last 1� years.�,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)

i EGMs such as VLTs and slot machines are technologically complex, but simple to use machines characterized by fast speed of play, bright colours, music, f lashing lights, and random payout schedules. Whereas slot ma-chines 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,� 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.

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 in-dividual player are the primary determinants of trouble-free gambling. However, the providers of gambling, like the providers of any product,

“bottomed out” more quickly than those who played more traditional games.� 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,� Clinical studies also show that among problem gamblers seeking treatment, use of EGMs tend to be the most common form of gambling engaged in.8-1�

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 con-comitant 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 oth-er forms of gambling.1� The RGC analyzed their 2005 preva-lence data on gambling and problem gambling in Ontario and found that EGM play was the strongest independent pre-dictor 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 evi-dence as to whether EGMs lead to problem gambling, there is consensus in the literature that EGM use and problem gam-bling 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

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.

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variables that have been examined in many of these studies may be classified into three general areas: 1) EGM features, 2) venue features, and �) community accessibility features.1,

20-2� 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 modifica-tions 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 gam-bling Researchers, Specialists (i.e., health and problem gam-bling 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 frame-work 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 ad-ministered 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 �);

A discussion of the study’s main findings and limitations (Chapter �); 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.

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1 LITERATURE REVIEW

EGM FEATURESIn 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 characteris-tics 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 fea-tures (RGFs). The research literature found on each of these features is discussed in turn below.

Speed of PlaySpeed 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 char-acterized 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 prob-lem gambling. Aside from the term problem gambling itself, some of these terms include compulsive gambling, pathological gambling, probable path-ological 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 gam-bling. One study conducted in Australian hotels and clubs with problem gamblers and non-problem gamblers exam-ined 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 en-joyment and satisfaction with the slower 5-second reel spin speed (lowered from �.5 seconds). Rapid speed of play (i.e., �.5 seconds) was not found to have any positive or negative impact on any of the parameters of play (i.e., time spent play-ing, 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 re-search.2�, 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 manip-ulations of speed and sound under three conditions: 1) de-creased speed/no sound, 2) standard speed/standard sound (control condition), and �) 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 confoundingiv 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 = ��). 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-sec-

iv In research, confounding occurs when variables of interest are not properly controlled for. This results in the researcher being unable to de-termine the impact of any one variable on the observed result, thereby limiting their ability to draw conclusions about cause and effect.

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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 re-strictions are not an important harm minimization strategy.26

However, it should be recognized that there are some signifi-cant limitations to the study’s generalizability. First, the study was conducted in a laboratory setting and thus may not ap-ply 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 prob-lem 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 gam-bler 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 signifi-cant 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 al-lows players to influence to some extent their length of play-ing 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 occa-sional, non-problem, VLT gamblers demonstrated that play-ers developed the illusion that their chances of winning were improved when the stop feature was used. Specifically, 8�% believed that stopping the reels would bring different symbols on the screen, 5�% 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. 2� 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 non-problem 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 reduc-ing 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 = �0�) and VLT players specifi-cally (N = 865) at each phase of the study to ascertain the ef-fect 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 1�% 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 ��6 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 �0% were in favour of the stop button re-moval/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, musi-cal tunes after a win, and “realistic” noises such as the sound of coins falling into a tray.20, 29

Association with problem gambling. It has been suggested in the literature that certain features of music may be associ-

11


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 gam-bler 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 mem-orable 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 los-ing is not identified by music.�0, �1

A number of studies found in our review looked at the rela-tionship between machine sound effects and problem gam-bling. In the first study, participants (N = �82) ranked 1� 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 two-thirds 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 conse-quences 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 attrac-tive to them. Findings indicated that �0% 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�2. 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.��

In terms of the impact that modifying EGM sound effects might have on problem gambling, the laboratory study re-viewed 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 con-founded 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 reduc-ing sound volume or removing sound altogether from EGMs were found.

Visual Effects

Definition. Visual effects on EGMs can include flashing lights, primary colours, furnishings and iconology.5, 20

Association with problem gambling. The literature on visual effects is quite limited and has not changed much in the last 1� years.�1 One empirical study looking at the effect of co-loured lighting on gambling behaviour found that non-prob-lem gamblers placed more bets and lost more money when they were exposed to red, as compared to blue, lighting (pre-sumably because red lighting is more arousing). �� 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).�1, �� It has also been suggested that primary colours and flashing lights contribute to the air of fun and excitement of playing on an EGM.��,�5

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 �0% of the

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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.�2 Recall, how-ever, 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 con-tinually 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 play-ing time by 15%, due to fewer breaks being taken to obtain proper change and less downtime being spent refilling coin hoppers.�6 The risk of problem gambling potentially increases with larger denomination bill acceptors because they effec-tively allow larger amounts of money to be converted into credits at one time.v

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 posi-tive 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.��

v Research on bill acceptors seems to be focused only on the relation-ship 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 2�% of non-problem gam-blers. The authors of the study stated that the bill acceptors decrease the need for breaks, and thus the opportunity to reflect on gambling activity.�8 Similarly, a community sur-vey (N = �55) 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.�9

A study exploring the impact of limiting EGM bill acceptors to $20 was conducted in Queensland, Australia. Two meth-ods of data collection were used. The first involved interviews with study participants (N = �59); the second involved an analysis of EGM revenues generated during the experimental period. Results revealed that 61% of those interviewed ap-proved 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 (�0-�0% 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 implementa-tion 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.�0

A second study was found looking at the impact of modify-ing EGMs in a number of ways, including limiting bill accep-tors to a maximum of $20. The study sample included recre-ational and problem gamblers frequenting clubs and hotels. The results revealed that while limited denomination bill ac-ceptors (i.e., $20) reduced overall machine expenditure, rec-reational 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

1�


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 consis-tent with anecdotal reports obtained from problem gamblers in focus groups who indicated that limiting the denomina-tion of bill acceptors would be unlikely to lead to changes in their patterns of play.2�, 25

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.�1

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 con-venient 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 reg-ulators in 1996 agreed to let casino patrons use credit and debit cards to purchase gambling chips and slot tokens, prob-lem 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.�2 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 explor-ing 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 actu-ally 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 dis-play of money wagered in the form of credits is also called tokenization.2�

Association with problem gambling. While the ability to in-sert money into a machine to obtain credits may be a con-venient feature (i.e., it saves the gambler from having to ex-change 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 prob-lem 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 evi-dence 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 op-posed 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 wager-ing decisions.��,�� 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.2� 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.�1

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-

1�


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 sup-port this hypothesis. Similarly, no research could be found that addresses the potential impact that modifications to pay-out 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 win-nings 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 behav-iour of EGM players. The first study involved interviews with self-identified problem gamblers (N = 16), recreational gam-blers (N = �5), gaming managers (N = 60), community rep-resentatives, 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 recreation-al gamblers, and �2% 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.�6

The second study looked at EGM players’ (N = �18) attitudes, awareness, beliefs, perceptions, challenges and behaviours re-lated to a number of harm minimization strategies, including payment of winnings by cheque. Results revealed that ��% of EGM players thought that payment by cheque for winnings

in excess of $2,000 would be an effective harm minimiza-tion 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.�5

Betting Options

Bet Size (Amount/Lines)

Definition. Bet size is determined by a number of factors, in-cluding the denomination of the machines (the value of each credit), the number of lines one can bet on, and the num-ber 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).22,2�

A study conducted in Australian hotels and clubs with prob-lem gamblers and non-problem gamblers examined the im-pact 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 great-er than $1, problem gamblers were three times more likely than recreational gamblers to wager with the larger amount.

15


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 proportion of players.2�, 2�

EGM-based Inducements

Near-misses

Definition. A near-miss on an EGM occurs when one ap-pears to come close to, but does not actually succeed at, win-ning a prize. For example, in the case of a three-reel slot ma-chine 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.��,�8 This possibility was explored in a study conducted with a sample of non-problem gambling university students ( N = �2). In this study, the experimental group was exposed to 2�% near-misses, while a second, control group, was ex-posed to none at all. Results revealed that those exposed to the near-misses played ��% 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.�9

A second study, using an unspecified sample, examined three rates of near-miss presentation--0%, ��% and 6�%--on gambling persistence using a computerized roulette game. A near-miss was operationally defined as an outcome with few-er than three numbers away from the number that had been chosen for the wager. Results revealed that half of the par-ticipants in the ��% condition made additional bets during the free-choice period, while none of the participants in the other conditions did.��, 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 con-tinues to believe that subsequent wins are likely. 51 Given that the authors of this study did not describe the problem gam-bling 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 stu-dents (N = 180) in the laboratory, examined three rates of near-miss presentation--15%, �0% and �5%--on EGM gam-bling 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 �0% near-miss condition led to greater persistence than did the 15% or �5% 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.�8 However, similar to the previous study, we do not know from this research whether near-misses dif-ferentially 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 �% 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 incon-sistency, the external validity of this study is limited.

Reel Display

Definition. Some EGMs are programmed to prolong the pre-sentation of a bet’s final outcome and thereby increase antici-pation. 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 in-stantaneous 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

16


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 switch-ing 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 po-tentially increasing machine traffic. 5� 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.”�0 In terms of the excitement factor of bonus rounds, a study was conducted looking at frequent-, infrequent- and non- gamblers’ (N = 6�) 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.5�

Association with problem gambling. There is some evidence to suggest that bonus features, specifically free games, are po-tent 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; how-ever, 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 conse-quently be only three methods of winning; however, in a situ-ation 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, re-sulting 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 pos-sible 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 identi-fied 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) 5� tokens with probability 0.15, or �) 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 (�8% versus 2�%, 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 me-dium prizes may prolong time spent gambling.56

1�


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 re-turn, however, and is unlikely to be relevant for a given gam-bling 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 excite-ment value.55 Gambling venues normally set their own pay-out rate, usually based on the jurisdiction’s rules.5�

Association with problem gambling. A study exploring the association between payout rate and problem gambling was conducted with college students (N = 6�) who did not dis-play 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 �5%, to 8�%, 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 possi-ble that the participants were not sensitive to the experimen-tal 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 gam-bling 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 re-ceiving larger wins, whereas gambling behaviour was main-tained with smaller wins.61

EGM-based Responsible Gambling Features (RGFs) Definition. With regard to EGMs, responsible gambling fea-tures (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 gam-bling. They are also less likely to adhere to their budgets when they do set them.6� 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 fea-tures 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 mea-sures, 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 re-sponsible 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, �) pop-up reminders of the total time spent play-ing (occurring at 60-, 90-, and 120- minute intervals), and �) five-minute cash-out warnings (at 1�5 minutes, with a man-datory cash-out at 150 minutes). A concomitant analysis was conducted with non-problem and problem VLT players ex-ploring the efficacy of these responsible gambling modifica-tions. The evaluation included a pre- and post- modification assessment of players’ awareness of the new features, changes in their behaviour, perceptions and attitudes, and recom-mendations for further improvements to the modifications.

Findings revealed that, overall, awareness of the modified VLTs ranged from �2% at the beginning of the study, to 9�% 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

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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 expendi-ture. Displaying cash totals instead of credits was the modi-fication 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.�1

In 200�/0�, 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 �0-minute pop-up message indicating the total time spent playing, and �) a mandatory response requirement to continue play. The eval-uation included a pre- and post- modification assessment of players’ awareness of the new features, changes in their be-haviour, perceptions and attitudes, and recommendations for further improvements to the modifications. Findings indicated that for optional time limits, �2% 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 man-age their budget. In terms of the �0-minute pop-up message, �5% of players were aware of the feature, but 8�% 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 �1% of those exposed to it during play felt that it would have no impact on their behaviour.6�

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 play-ers exposed to VLTs with responsible gambling features. The features included: 1) time clocks, 2) pop-up time remind-ers, �) money counters (displays that showed the amount of money spent during play), and �) 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 be-lieved that the clock and money counters were at least some-what 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 effec-tive in helping them decide whether to cash out or stop play-ing. 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 modifica-tions 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.6�

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 op-erationalized 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 re-strictions on their play, such as setting the duration of play and/or a budget for a given time period.�8, 66

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 prob-lem VLT gamblers. Findings revealed that 50% of study par-ticipants thought that the cards would be useful if they were made mandatory. Moreover, irrespective of gambling status, 8�% of participants supported or strongly supported having

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the cards made mandatory for anyone wanting to play VLTs in Nova Scotia.6�

A second, questionnaire-based study among patrons of two Australian clubs (N = 1��), assessed consumer responses to a number of RGFs including the use of smart cards66 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 activ-ity 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 ap-proaches be explored. The author also concluded that more frequent players (i.e., more at-risk gamblers) may be attract-ed 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 con-cern is potentially offset by the lack of anonymity that accom-panies 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 card-based 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 play-ing EGMs once a gambling session has begun.�1 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.�5 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 �) industry and community stakeholders. The purpose of the study was to assess the effectiveness of vari-ous 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 per-son 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.�5

Responsible Gambling Messages

Definition. Many gamblers hold false beliefs about gambling and the extent to which they can control or predict gambling outcomes.69, �0 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 mes-sages during play on gambling behaviour. The first, a labo-ratory 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 discuss-ing irrational beliefs expressed by gamblers. Those in the ex-perimental 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 sig-nificantly fewer irrational beliefs and spent significantly less money than did those in the control condition.�1

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 con-sider changing their gambling behaviour and/or call a prob-lem 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?”

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b) “Are you gambling longer than planned?” and c) “Have you ever felt bad or guilty about your gambling?” The gam-blers 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 activ-ity. 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 con-cluded 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.�2

VENUE FEATURESIn 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 de-sign, advertising, and venue-based harm minimization strate-gies. 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.�6

Only one study was found in our review that speaks to this issue, albeit tangentially. The primary focus of the study, con-ducted in New South Wales, Australia, was to assess the im-

pact 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.��

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 re-ducing 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 = �11). In terms of findings, the authors of the study reported that terminal reduction result-ed in a decrease of spending for 12% of the total VLT player base, with problem gamblers decreasing their spending by an average of $1�6 per week. Similarly, VLT players reduced their time spent playing VLTs by an average of �0 minutes per week, with problem gamblers reducing their time spent play-ing 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 gam-bling is directly related to the degree to which patrons can access EGMs.�8 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 man-datory venue closures to force breaks in play.�6

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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 ma-chines down between 6 am to 9 am) had for problem gam-blers, their families, recreational gamblers, and venue manag-ers. 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 shut-down was good in principle, in practice they did not think it made sense as an effective harm reduction strategy. Their ra-tionale 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 con-sidered 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 (�2%) 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.��

A second Australian study also looked at the effect of en-forcing a three-hour shutdown in 1� clubs either between � am and � am, or between 6 am and 9 am, depending on the jurisdiction. Evaluations were conducted using in-depth in-person 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 �% 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.�6

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 � 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., 5�% 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 gam-blers 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 behav-iours of those most at risk.��

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 col-lected between 1991 and 1998 from riverboats and racinos in Iowa, Illinois, and Missouri (N = 15� observations), the authors of the study found that restricting boarding times re-sulted in a �5% reduction in EGM gambling.�5

Venue Conveniences

ATMs

Definition. It is often thought that access to ATMs (automat-ed 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.�8 Similarly, a telephone survey probing EGM players (N = 2�0) in Australia about their ability to keep within pre-committed spending limits found that �1% admitted to exceeding these limits, es-pecially if they had cash on their person or they could access it at an ATM.59

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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 1� regions of Australia found that more self-identified problem gamblers (60%) visited ATMs at gaming venues than did regular gamblers (25%), recreational gamblers (1�%), and non-gamblers (5%). It also found that ATM withdrawals of $100 or more were more common among problem gam-blers than non-problem gamblers, and that 9�% and 90% of regular and problem gamblers, respectively, spent their ATM withdrawals at the gaming venue compared to �0% of recre-ational 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, par-ticipants did support both the notion of placing limits on the number of ATM withdrawals one could make and the plac-ing of bans on credit card cash advances (86% and �2% 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 es-tablish daily maximum ATM withdrawal amounts.�9

A second survey conducted in Victoria, Australia looked at EGM players’ (N = �18) attitudes, awareness, beliefs, per-ceptions, challenges and behaviours relating to a number of harm minimization strategies. It found that moderate-risk and problem gamblers made significantly more ATM with-drawals than non-problem or low-risk EGM players. ATM usage was also a significant, independent predictor of prob-lem gambling. Furthermore, the majority of EGM players, ir-respective 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.�5

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 ven-ues 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 ��% of VLT players reported drink-ing alcohol while gambling.�6 Other research has found that gamblers who drink alcohol during play are more likely to be problem gamblers.�� 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.�8-80

Research also suggests that the impact of alcohol may differ for non-problem as opposed to problem gamblers. For exam-ple, one VLT study was found in our review that examined the effects of moderate alcohol intake (� alcoholic drinks) among community gamblers characterized as either non-problem 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.�8

A further relationship between alcohol use and problem gambling has been noted for problem gamblers with co-mor-bid 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 gen-eral (e.g., suicidal behaviour, drug problems) when compared to those problem gamblers without alcohol problems.81 In

2�


support of this argument, an examination of problem gam-blers who called a gambling helpline found that those prob-lem 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 re-stricting 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 nat-ural 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.�8

Research has been conducted, however, confirming that ven-ues 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 as-sessing club patrons’ (N = 86�) awareness and perceived ef-fectiveness of certain responsible gambling strategies includ-ing increasing the visibility of clocks in venues and improv-ing 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 (�8%), 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 = �18) 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 �9% thought that clearly visible wall clocks in gaming venues would be an effective measure for reduc-ing 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 �6% said that the introduc-tion of natural lighting in the gaming area would be an effec-tive harm minimization strategy.�5

Placement of EGMs

Definition. Some researchers have speculated that because of their design or format, certain gaming venues (e.g., casi-nos) are more conducive to player anonymity than are oth-ers. 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.�6

Association with problem gambling. To date, only one labora-tory 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 gam-blers (N = 60). In terms of venue format, � 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 �) EGMs were isolated in cubicles. Results revealed that among participants who reported being influ-enced 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, ��% identified the cubicle arrange-ment 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.8�

Advertising

Prize Advertisements

Definition. Venue advertisements of EGMs may depict ordi-nary people winning millions of dollars from a single coin in-serted 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.8�

Association with problem gambling. The literature on the re-lationship 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 demo-graphic and clinical features of problem gamblers (N = 1�1). Relevant to this discussion was the study’s focus on triggers that provoked the urge to gamble. Results indicated that �6% of the sample reported that gambling-related advertisements on television, radio, and billboards triggered their gambling.

2�


Moreover, those participants who were triggered by the ad-vertising 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 re-lationship 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 ca-sinos—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 unspeci-fied period of time.

Association with responsible gambling. To date, there is little research on the effectiveness of SE, and among the few stud-ies 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 �0% of participants new to the program completely stopped gambling once enrolled. Of those who were repeat self-ex-cluders (i.e., they had re-entered the self-exclusion program a second time or more), �6% reported that in their last attempt, they broke their ban and returned to the casino; 50% admit-ted 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-ex-cluders reporting a high rate of satisfaction (9�%), and even second time self-excluders reporting a high rate of satisfac-tion (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-exclu-

sion was extremely limited and not focused on outcomes. What is more, they stated that it was not possible to mean-ingfully comment on compliance by venues, rates of detec-tion, 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 actu-ally make them effective.8�

As with the above studies, most of the published research on SE is casino-based. Thus, it reveals very little about the pos-sible effectiveness of SE from other (non-casino) EGM ven-ues. 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 = �5), designated and trained program retail support staff (N ~ 150) and regular, local, and non-local EGM players (N = �6). Results revealed that �5% 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 �.� times if the players were local (as opposed to non-local), 2.� times if the report was generated later in the day and 2.8 times if the re-port was generated in a private facility compared to a public facility. The researchers attributed the difficulty in recogniz-ing and accurately reporting on SE participants who are vio-lating their ban to a number of factors, including the busy setting of the venues, lack of any objective means of confirm-ing 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 con-duit for intervening with a problem gambler.55 Some exam-ples 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.

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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.6� 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 initia-tives to educate patrons about problem and responsible gam-bling 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 edu-cation initiatives in 10 clubs in Sydney, Australia. Findings revealed that there was a high level of awareness of the sig-nage and information measures employed. Specifically, 86% of respondents noticed signage advising patrons of the risks of gambling, over �0% noticed signage about the club’s re-sponsible gambling house policies, and over 6�% noticed sig-nage about the chances of winning a major prize.11 However, despite the high level of awareness, the majority of respon-dents claimed that the signage had little effect on either their gambling perceptions or behaviours. Specifically only ��% 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 evalu-ated the effectiveness of new responsible gambling features installed on VLTs to mitigate problem gambling.6� As part of pre-test data collection (prior to installation of new VLTs with responsible gambling features), information was gath-ered about patrons’ awareness of responsible gambling sig-nage, as well as patrons’ responses to signage. Findings re-vealed varying levels of awareness of responsible gambling signage, with half of all sampled patrons reporting aware-ness 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, al-most 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 FEATURESA third category of features associated with EGMs and prob-lem 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 lit-erature suggesting a positive link between gambling oppor-tunities and problem gambling, both in Canada and the rest of the world.1�,�8,90-9� One example of this is found in a replica-tion study that compared two surveys conducted in Quebec: The first in 1989, the second in 1996.96, 9� Not only did the study find past- year gambling participation rates to have significantly increased between the two survey years (from 5�% to 6�%), it also found lifetime rates of pathological gam-bling 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, casi-nos, and VLTs in the province.95 Similarly, a study in Ontario found that gambling participation among substance abusers

26


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 high-est 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.9� Finally, a meta-analysis of �� studies of gambling problems among adults in North America from 19��-199� indicated that problem gambling increased over time as gambling oppor-tunities 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.�% in 1996 and 1.8% in 2002. 9�,100 Research in British Columbia found that levels of problem gambling and probable pathological gambling among past year and weekly gamblers remained unchanged between 199�, 1996, and 2002.101 Research in Alberta found similar prevalence rates of problem gambling between 199�, 1998, and 2001. Finally, research in Manitoba found a “mi-nor” increase in “probable pathological gambling” in 2001 (2.�%) compared to 1995 (1.9%).102

The relative stability of problem gambling rates from 2000 onward has been explained by both the saturation and so-cial adaptation models of the impact of gambling exposure on problem gambling rates.10� The saturation model predicts an initial increase in problem gambling rates following the introduction of gambling opportunities, followed by a pla-teau. The social adaptation model predicts a gradual plateau in problem gambling rates, followed by a decrease as the nov-elty of the new gambling opportunities diminish.

Given the conflicting correlational evidence regarding com-munity accessibility and problem gambling, numerous stud-ies have been conducted which attempt to make sense of the underlying relationship between the two variables. These studies are discussed below.

Number of EGM VenuesDefinition. 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 op-portunities 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 num-ber of people having access to such opportunities.�8 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 con-trol over gambling among those with gambling problems. Conversely, confining machines to a limited number of loca-tions is seen as a factor that would promote control.2�, 8�

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 re-gion, Victoria, had EGMs located in 5�0 venues. Data was obtained from community surveys undertaken to assess at-titudes and behaviours relevant to participation in gambling, and from interviews with a variety of stakeholders. Results revealed that compared to Western Australia (where gam-bling 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 gam-bling were 1�.5 times greater, and the estimate of problem gambling was � times higher.10�

Proximity of EGM VenuesDefinition. The proximity of EGM venues refers to the geo-graphical or spatial distance of EGM venues to potential consumers.

Association with problem gambling. Venues that are conve-niently 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,

2�


Australia, (N = 2,��) examined whether geographical prox-imity was a significant factor influencing gambling-related activity. The results revealed that those who lived within close proximity (i.e., within � kms) of an EGM site reported great-er 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 = 2,9��), 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 prob-lem gambling compared to respondents who lived between 51 and 250 miles away from a casino.9�

EGM Caps Definition. The expansion of EGM availability and its link to increased risk of problem gambling has led many juris-dictions 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 num-ber of machines per se.�8

Association with problem gambling. Only one study look-ing 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, den-sity of EGMs per capita, and socioeconomic status). Results showed that the capping of EGMs in these areas was not as-sociated 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.10�

While no other studies have examined EGM caps, it should be noted that policy analyst Michael O’Neil has concluded that the removal of �,000 machines from South Australian venues did not affect overall net EGM revenue. Additionally, he reported that the majority of regular and problem gam-blers did not believe that the reduction of EGM machines

had a positive effect on problem gambling in general or on their own behaviour specifically.��

Number of EGMs per Capita (Density)Definition. One common definition of EGM accessibility is the density of EGMs within a population, defined by the num-ber of EGMs per capita (e.g., per 1,000 people). Five EGMs per 1,000 people can be considered relatively low, while �8 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 expen-diture is quite strong.28, 10�, 108 For instance, recall the previous-ly 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 through-out 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 associa-tion between EGM density and gambling participation uti-lizing 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 communi-ties. 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 ex-penditure or measures of social disadvantage.109 The authors concluded that using EGM density as a measure of accessi-bility is too simplistic because it does not take into consid-eration other factors, such as type or combination of gam-ing machines, proximity of venues to community facilities, consumer preferences, venues’ marketing strategies, changes in urban and economic conditions, etc.108 Again, however,

28


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 socio-economically disadvantaged areas, ostensibly because they facilitate economic development and job creation.106, 110

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 disad-vantaged communities, the local community housing the ca-sino may bear the biggest share of problem gambling; yet so-cio-economically disadvantaged communities are least likely to have the resources available to handle this problem.11�

A number of studies were found in our review which con-firms 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 anal-yses 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 �0% greater for students at-tending schools in neighbourhoods with high VLT access.11�

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-eco-nomically 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 pop-ulation. In doing so, the spatial distribution of gaming ven-ues 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 �5% of the total number of NCGMs, while the two most affluent areas housed approximately �%

of the total number of NCGMs. In addition, according to the results obtained from the 2002/200� New Zealand health sur-vey,115 the overall problem gambling rates (not just the rates for gaming machine-associated problem gambling) were 2.� times greater in the areas with the most socio-economic de-privation 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 gam-bling 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 gam-bling 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 disad-vantaged communities.106

SUMMARYNumerous studies have attempted to shed light on the factors that either increase, or decrease, EGM-related problem gam-bling. 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 work-ing 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.

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2 KEY INFORMANT QUESTIONNAIRE

METHODOLOGY

ParticipantsA total of 69 Key Informants from across Canada and abroad were asked to provide their opinions on EGM-related prob-lem gambling via questionnaires, interviews, and/or focus groups. Key Informants included:

Problem gambling Researchers, identified through the published literature and/or per-sonal referral;

Gaming and problem gambling Specialists (i.e., health and problem gambling profession-als, 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 � discusses the method and results of the focus groups, while Appendices 6 and � cover the Counsellor Interviews.vii For a complete list of Key Informants asked to participate in this study, please see Appendix 1.

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.

1.

2.

�.

�.

Response RateThe 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, �9 Researchers and Specialists were invited to com-plete 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 ques-tionnaire was 60.9%.

QuestionnaireThe comprehensive questionnaire given to Key Informants was divided into two main sections, each of which is de-scribed in detail below. Note that while the questionnaire

viii Counsellors and Problem Gamblers were each given a $50 honorari-um 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.

TABLE 1 Questionnaire Response Rates

Group

Asked to Complete

Questionnaire (n)

Completed Questionnaire

(n)

Response Rate (%)

Researchers/Specialists

49 25 51 0

Counsellors 8 5 62 5

Problem Gamblers

12 12 100 0

Total 69 42 60 9

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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 ver-sion that had some items omitted. For a complete copy of the questionnaire, please see Appendix 2.

Section A: Contributors to Problem GamblingIn 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 accessibil-ity 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 ques-tions 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 �

Section B: Modifications to Reduce Problem GamblingIn 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 ac-cessibility features would be in reducing the risk of problem gambling. They were also asked to indicate, on a �-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 modifica-tions was requested, along with any additional modification that had not been previously mentioned. Again, given that all quantitative questions were subsequently ranked, the open-ended 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 addi-tional modifications not mentioned, please see Appendix �.

Finally, participants were asked to give their thoughts re-garding any improvements they would make to venue-based harm minimization strategies (i.e., self-exclusion programs, patron information and education initiatives, and staff train-ing 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 PlanOnly 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 �� 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 �� 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 rank-ing of item mean importance scores for each Key Informant group; and 2) Thematic analysis. Below is a more detailed de-scription 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 frame-work 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 specif-ic 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.x For this set of analyses, the results for Researchers and Specialists are examined separately. Please see Appendix � for tables of all rank-ordered means by Key Informant group.

ix The standard error is the standard deviation of a sampling distribu-tion. More generally, it indicates the amount of variation of some statistic, in this case the mean, in units given by the question.116

x A quartile divides the sorted data set into four equal parts so that each part represents 1/� of the sample. Thus, the top quartile cuts off the high-est 25% of data, while the bottom, or �th quartile, cuts off the lowest 25%.

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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 (com-munity accessibility), we decided that an item-based analysis was sufficient and, therefore, the thematic analysis was ap-plied 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 or-der to identify any clusters that contained negatively corre-lated 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 sum-ming together all individual respondents’ item scores within a given cluster and dividing by the total number of respon-dents. A higher mean indicates greater thematic importance for the respondents. We looked at 95% confidence inter-vals (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% confi-dence interval indicates the range within which one can be 95% confident that the true mean falls. For example, a mean of 2.� with a CI:1.8 – �.6 would indicate that the true mean falls somewhere between 1.8 and �.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.

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Results

EGM Features that Contribute to Problem Gambling


Researchers’ Opinions. Researchers were asked to assess the importance of 2� EGM features in contributing to problem gambling. The mean importance scores for these features ranged from �.5� to 2.5�. The EGM features that were per-ceived 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 high-est mean importance score (M = �.5�), followed by direct electronic fund transfers at machine (M = �.�8), the appear-ance of almost winning (M = �.2�), and bill acceptors (M = �.15). Machines equipped with high denomination bill ac-ceptors, stop buttons, and variable prize value mixtures each had identical scores (M = �.92). Among most of these fac-

tors, speed seems to be an underlying theme (i.e., fast speed of play, stop button) as is method of payment (i.e., direct elec-tronic fund transfers, bill acceptors).

The EGM features that were seen to be the least important contributors to problem gambling were related to the pro-grammable 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 in-dividual spins), all shared the lowest mean scores (M = 2.5�). 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 2� EGM features in contributing to prob-lem gambling. The mean importance scores for these features

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

EGM FeatureMean Importance

Score(SE)

Item Rank N

Most Important Contributors

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)

3 92 ( 24) 6 13

Least Important Contributors

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

��


ranged from �.00 to 2.08. The EGM features perceived to be the most important and least important contributors to prob-lem gambling for this group are presented in Table �.

As shown, the Specialists thought that the most important EGM contributors to problem gambling were direct elec-tronic fund transfers at machines (M = �.00), followed by the appearance of almost winning (M = �.8�), and fast speed of play (M = �.�5). Lastly, bill acceptors and frequent presenta-tion of big prize symbols during play were also ranked highly as important contributors to problem gambling (M = �.58 for each).

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.�2), as well as lower house advantage (M = 2.�2) and lower hit rates (M = 2.50). The Specialists also rated machine sound (M = 2.�2) and visual (M = 2.58) effects, as well as small de-

nomination minimum betting amounts (M = 2.�6), among the least important EGM contributors to problem gambling.

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

EGM FeatureMean Importance

Score (SE)

Item Rank N


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


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

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

Cluster ItemThematic Mean

Importance Score (95% CI)

Speed of Play- Fast speed of play (e g , shorter time between initial bet and outcome)

- Player controlled stop button

3 92 (3 58-4 26)N=25

Payment Methods

- 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

3 72 (3 31-4 13)N=25


- 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)

3 68 (3 36-4 00)N=25

Betting Options

- 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)

3 21 (2 91-3 52)N=25


- 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

�5



For this analysis, the 2� EGM feature items were grouped to-gether into eight clusters. Thematic mean importance scores for each cluster, based on the total Key Informant sample (Researchers and Specialists), are shown in Table � (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 = �.92), payment methods (M = �.�2), and EGM-based inducements (M = �.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 = �.2�) rated speed of play as a more important contributor to problem gambling than did the Specialists (M = �.60) (t = 2.09, df = 2�, p<.05).

Venue Features that Contribute to Problem Gambling


Researchers’ Opinions. Researchers were asked to assess the importance of 1� venue features in contributing to prob-lem gambling. The mean importance scores for this group were found to range between �.08 and 2.�1. Table 5 presents Researchers’ mean scores and standard errors (SE) for the most and least important contributors to problem gambling.

As the table shows, two items shared the highest mean impor-tance scores. These were ATM machines located on the gam-ing floor or close to machines, and 24-hour access to EGMs in venues (M = �.08 for both). These items were followed by EGMs located in non-dedicated gaming venues and targeted player EGM marketing; each received identical mean scores of �.85. Venue contributors that Researchers perceived to be least important for problem gambling were the absence of venue clocks (M = 2.�1) and windows (M = 2.5�), low visibil-ity of EGMs within the venue (M = 2.�6), and EGMs located in a dedicated gaming venue (M = 2.92).

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

Venue Feature

Mean Importance

Score (SE)

Item Rank

N


ATMs located on gaming floor or close to machines

4 08 ( 31) 1 5 13

24 hour access to EGMs in venue

4 08 ( 24) 1 5 13

EGMs located in non-dedicated gaming venue (e g , bar, hotel)

3 85 ( 34) 3 5 13

Targeted player marketing for EGMs

3 85 ( 22) 3 5 13


No clocks in venue 2 31 ( 26) 14 13

Low visibility of the EGMs within the venue

2 46 ( 33) 13 13

No windows in venue 2 54 ( 27) 12 13

EGMs located in a dedicated gaming venue (e g , casino, racetrack)

2 92 ( 29) 11 13

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Specialists’ Opinions. Specialists also assessed the importance of 1� venue-related features in contributing to problem gam-bling. Mean importance scores for Specialists were found to range from �.�� 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 = �.��), followed by targeted player EGM mar-keting (M = �.�0), and 24-hour access to EGMs within the venue (M = �.�6). 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 = 2.2�), 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.��).


The 1� 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 � on the opposite page.

As can be seen from the table, although items related to venue conveniences had the highest mean score (M = �.5�), when considering the confidence intervals, this score was not significantly higher than the scores for EGM accessibil-ity, 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 be-tween the two Key Informant groups, we found that EGM accessibility was a more important cluster for Researchers (M = �.69) than it was for Specialists (M = 2.8�) (t = 2.�, df = 2�, p<. 05). A between-group difference was also ob-served for venue type, with it being more important, again, to Researchers (M = �.�8) than Specialists (M = 2.�1) (t = 2.�, df = 2�, p=.05).

Community Accessibility Features that Contribute to Problem Gambling


Researchers’ Opinions. Researchers were asked how impor-tant six items related to community accessibility were for contributing to problem gambling. The mean importance scores ranged from �.�6 to �.00. Since there were only six

items, the mean importance scores and standard errors for every item in this framework area are presented in Table 8.

As the table shows, Researchers generally rated each of the community accessibility items as highly important (i.e., M ≥ �.00). The highest mean score was given to the item, large number of venues with EGMs (M = �.�6), while the low-est mean score was given to the item, large total number of EGMs in community (M = �.00).

Specialists’ Opinions. Specialists were also asked how impor-tant the six items related to community accessibility were as contributors to problem gambling. Specialists mean impor-tance scores ranged from �.82 to �.20. All Specialists’ mean scores and standard errors (SE) for this framework area are presented in Table 9.

As seen in the table, the most important contributor to prob-lem gambling for Specialists was wide dispersion of EGMs throughout community (M = �.82). This item was followed by a large number of community venues with EGMs (M = �.6�), convenient location of EGM venues (M = �.55), large number of EGMs per capita (M = �.�5), and large total num-ber of EGMs in community (M = �.�6). The item seen as least important was over concentration of EGMs in low income neighbourhoods (M = �.20).

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

Venue Feature

Mean Importance

Score (SE)

Item Rank

N


ATMs located on gaming floor or close to machines

3 73 ( 33) 1 11

Targeted player marketing for EGMs

3 40 ( 31) 2 10

24 hour access to EGMs in venue

3 36 ( 39) 3 11


No clocks in venue 1 91 ( 21) 14 11

No windows in venue 2 18 ( 33) 13 11

Low visibility of the EGMs within the venue

2 27 ( 27) 12 11

Large number of EGMs within venue

2 33 ( 26) 11 12

��


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


Importance Score(95% CI)

Venue Conveniences

- ATMs located on gaming floor or close to machines

- ATMs located anywhere in the EGM venue

- Easy access to alcohol

3 53 (3 15-3 91)N = 24

EGM Accessibility

- Large number of EGMs within venue

- 24 hour access to EGMs in venue

- Full access to EGMs for play in venue

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)

Community Accessibility Feature

Mean Importance

Score (SE)

Item Rank

N

Large number of community venues (bars, lounges, casinos, other) with EGMs

4 46 ( 18) 1 13

Wide dispersion of EGMs throughout community

4 38 ( 21) 3 13

Convenient location of EGMs sites (e g , close proximity to high residential populations)

4 38 ( 18) 3 13

Over concentration of EGMs in low income neighbourhoods

4 38 ( 21) 3 13

Large number of EGMs per capita in community

4 23 ( 28) 5 13

Large total number of EGMs in community

4 00 ( 30) 6 13

TABLE 9 Community Accessibility Contributors to Problem Gambling (Specialists)

Community Accessibility Feature

Mean Importance

Score (SE)

Item Rank

N

Wide dispersion of EGMs throughout community

3 82 ( 35) 1 11

Large number of community venues (bars, lounges, casinos, other) with EGMs

3 64 ( 28) 2 11

Convenient location of EGMs sites (e g , close proximity to high residential populations)

3 55 ( 31) 3 11

Large number of EGMs per capita in community

3 45 ( 31) 4 11

Large total number of EGMs in community

3 36 ( 34) 5 11

Over concentration of EGMs in low income neighbourhoods

3 20 ( 36) 6 10

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SECTION B: MODIFICATIONS TO REDUCE PROBLEM GAMBLING

Data Analysis PlanSection B of the questionnaire can be broken down into two quantitative parts. The first asked respondents about the effectiveness of �6 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 �6 modifica-tions using a �-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 com-plete the second part (i.e., strength of evidence).

As with section A, after examining the results of the indi-vidual item rankings, we organized like items into clusters based on functional similarities.xiii All �6 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 cal-culated 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; �) Quartile placement of top and bottom ranking items were compared between Key Informant groups; and �) 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 frame-work area were seen as most and least effective for reducing problem gambling risk, we employed the same approach re-ported in Section A. That is, for each modification item, the mean effectiveness score and standard error (SE) were calcu-lated based on a 5-point scale (Not at all effective to Extremely

xiii Placement of items into clusters is thematically, not statistically, determined. As such, it is possible to group items into other thematic arrangements.

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 spe-cific framework area, while the least important were identi-fied 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 modifica-tion 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-�) of key items (i.e., top-rated items, bot-tom-rated items and other notable items, where appropriate) across the four groups. Please see Appendix � 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 omit-ted 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 modifi-cations that were assessed by the Counsellors and Problem Gamblers.

�) 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 distribu-tion. More generally, it indicates the amount of variation of some statistic, in this case the mean, in units given by the question.

xv A quartile divides the sorted data set into four equal parts so that each part represents 1/� of the sample. Thus, the top quartile cuts off the high-est 25% of data, while the bottom, or �th quartile, cuts off the lowest 25%.

�9


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 re-ferred 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 re-spondents. A higher mean indicates greater perceived effec-tiveness 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, sug-gesting greater perceived effectiveness for that thematic clus-ter.xvii Lastly, we looked for any possible differences in the-matic 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 Gambling1) 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% confi-dence interval indicates the range within which one can be 95% confident that the true mean falls. For example, a mean of 2.� with a CI:1.8 – �.6 would indicate that the true mean falls somewhere between 1.8 and �.6.

report their opinions regarding the strength of the evidence for the most and least effective modifications.

Researchers’ Opinions. Researchers were asked to assess �6 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’ percep-tions of the strength of evidence for each modification’s effectiveness.

As can be seen, researchers’ mean effectiveness scores ranged from �.�� to 1.�8. The most effective modifications were those related to restricting expenditures. The most effective item identified was eliminating electronic fund transfers at EGMs (M = �.��), followed by removing bill acceptors completely (M = �.50), and removing only large bill acceptors (M = �.�6). Moreover, providing mandatory (M = �.�8) and optional (M = �.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 = �.15) and optional setting of pre-determined time limits (M = �.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 restric-tions. Other items that scored highly were related to decreas-ing speed of play (i.e., increasing time between the outcome of one bet and the next bet, M = �.�1) and providing on-screen running cash totals of amount spent (M = �.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 stron-gest supporting evidence was mandatory registration and use of smart cards (��%). 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.

�0


several modifications emerged as having a relatively reason-able 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.�% indicated that there was rea-sonable evidence to support providing EGMs with on-screen running cash expenditure totals. Conversely, approximately 60% of Researchers indicated that there was only weak evi-dence available to support eliminating electronic fund trans-fers, 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.�8), decreasing house advantage (M = 1.��), increasing minimum bet size (M = 1.5�), and providing a problem gambling Helpline number and message on the back

of printed payout tickets (M = 1.��). As well, while the fol-lowing modifications did not receive the lowest mean effec-tiveness 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 contribu-tors 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 modifica-tions that Researchers believed had weaker evidential sup-port. In fact, there were only two modifications that were

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

EGM Modification

Mean Effectiveness

Score(SE)

Item Rank

N

Perceived Strength of Evidence for Effectiveness

NWeak

%Moderate

%Strong

%

Eliminating electronic fund transfers at the EGMs i e , direct debit

3 77 ( 36) 1 13 61 5 38 5 7 7 13

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)

3 46 ( 33) 3 5 13 38 5 46 2 15 4 13

Requiring mandatory registration and use of smart card to begin play

3 46 ( 40) 3 5 13 58 3 8 0 33 3 12

Requiring players to set pre-determined spending limits

3 38 ( 33) 5 13 50 0 33 3 16 7 12

Increasing time between the outcome of one bet and the next bet (i e , slowing play)

3 31 ( 29) 6 13 53 8 46 2 0 0 13

Requiring players to set a pre-determined time limit

3 15 ( 30) 7 5 13 61 5 38 5 0 0 13

Providing running cash totals of amount spent on screen

3 15 ( 41) 7 5 13 41 7 41 7 16 7 12

Providing an option to set personal pre-determined spending limits

3 00 ( 25) 9 5 13 50 0 50 0 0 0 12

Providing an option to set personal pre-determined time limits

3 00 ( 25) 9 5 13 61 5 38 5 0 0 13

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rated low on effectiveness for which 25% of Researchers claimed strong support. These two modifications were pro-viding 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 �6 EGM modifications. Results revealed that their mean ef-fectiveness scores ranged from �.00 to 1.��. 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 = �.00), eliminating electronic fund transfers at EGMs (M =

�.89), and pre-determined spending limit requirements (M = �.6�). In terms of the other types of spending restrictions, the removal of bill acceptors (M = �.22), the removal of high denomination bill acceptors (M = �.11), and the mandatory (M = �.1�) and optional (M = �.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 = �.1�) and re-moving stop buttons (M = �.00).

In terms of the strength of evidence supporting the most ef-fective modifications, the highest proportion of Specialists indicated that there was strong evidence for mandatory registration and use of smart cards (25%), eliminating elec-tronic 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

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

EGM Modification

Mean Effectiveness

Score (SE)

Item Rank

N


N

Weak %

Moderate %

Strong %

Increasing house advantage (i e , average amount taken per bet by gaming operator)

1 38 ( 18) 46 13 69 2 23 1 7 7 13

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

1 77 ( 17) 43 5 13 54 5 27 3 18 2 11

Decreasing house advantage (i e , average amount taken per bet by gaming operator)

1 77 ( 38) 43 5 13 76 9 23 1 0 0 13

Providing general information about responsible gambling on welcome screen

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

1 92 ( 27) 36 5 13 50 0 41 7 0 0 12

Displaying responsible gambling messages during play

1 92 ( 18) 36 5 13 50 0 25 0 25 0 12

Adding responsible gaming button leading to gambling information screens

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

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

EGM Modification

Mean Effectiveness

Score (SE)

Item Rank

N


NWeak

%Moderate

%Strong

%

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


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


1 57 ( 43) 39 5 7 85 7 14 3 0 0 7

Adding countdown clock showing time limit remaining

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

Displaying simultaneous (as opposed to sequential) presentation of reel outcomes

1 71 ( 18) 36 7 71 4 28 6 0 0 7

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

EGM Modification

Mean Effectiveness

Score (SE)

Item Rank

N


N

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


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

��


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 evi-dence to support the modifications believed to be most ef-fective. The Specialists were in unanimous (i.e., 100%) agree-ment that there was moderate to strong evidence supporting the removal of bill acceptors from EGMs.

Just below table 12, Table 1� 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 effec-tive for reducing problem gambling risk included cash pay-outs instead of tickets (M = 1.��) or tokens (M = 1.�8) and increasing the minimum bet size (M = 1.��). Specialists also did not seem to think that removing some types of games from EGMs (M = 1.��) or decreasing game variety (M = 1.��) would be effective in reducing problem gambling. Other items rated as being relatively ineffective included those related to in-creasing and decreasing house advantage (M = 1.6� and M = 1.5�, respectively), and increasing the chances of a win occur-ring (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 = 1.6�), and displaying simultaneous presentation of reel outcomes (M = 1.�1).

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 �0 EGM modifications to reduce problem gambling risk. Their mean effectiveness scores ranged widely from �.20 to 1.20. Table 1� presents the modifications that Counsellors perceived to be most effective.

As evidenced in the table, Counsellors believed the most ef-fective EGM modification to be requiring mandatory registra-tion/use of smart cards to begin play (M = �.20), which was the only item with a mean score higher than �.0. This modifi-cation 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 �.60.

Counsellors also indicated effective modifications to be play stoppages, breaks or interruptions (M = �.�0), and providing on EGM screens running cash expenditure totals (M = �.�0), time of play totals (M = �.20), and time of day (M = �.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 = �.�0). 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.

TABLE 14 Most Effective EGM Modifications (Counsellors)

EGM Modification

Mean Effectiveness

Score (SE)

Item Rank

N


4 20 ( 58) 1 5


3 60 ( 87) 2 5 5


3 60 ( 68) 2 5 5

Enforcing play stoppage, break or interruption

3 40 ( 81) 5 5


3 40 ( 98) 5 5

Eliminating electronic fund transfers at the EGMs (i e , direct debit)

3 40 ( 81) 5 5

Displaying total time of play on screen

3 20 ( 92) 7 5 5

Displaying time of day on screen 3 20 ( 92) 7 5 5

��


As Table 15 shows, Counsellors believed that increasing play-ers’ 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.�0) or tickets (M = 1.60) would be particularly effec-tive. 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 ma-chines (M = 2.00).

Problem Gamblers’ Opinions. In keeping with the Counsellors, Problem Gamblers assessed �0 EGM modifications. Their mean effectiveness scores also varied widely, ranging be-tween �.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 = �.00) and mandatory registration/use of smart cards (M = �.��) 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 modifica-tions (M = �.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-deter-mined spending limits made the top quartile (M = �.25 and M = �.09, respectively), such time-based modifications did not. Problem Gamblers also felt that removing bill acceptors from EGMs (M = �.08), as well as providing continuous on-screen running cash totals (M = �.1�) and displaying machine activity in cash value instead of credits (M = �.08), were ef-fective. Other items receiving high mean effectiveness scores included enforcing play stoppages, breaks, or interruptions (M = �.�2) and eliminating bonus rounds (M = �.08). The EGM modifications that the Problem Gamblers thought were least effective for reducing problem gambling risk are shown in Table 1�.

The table shows that Problem Gamblers felt that increasing minimum bet size (M = 1.25) was the least effective modifi-cation. 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 1.6�. Manipulations to the chances of winning--either wins overall (M = 1.6�) or small wins (M

= 1.��)--as well as decreasing (M = 1.8�) 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 gam-bling information screens (M = 1.91), and removing certain types of games on EGMs (M = 2.00).


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

TABLE 15 Least Effective EGM Modifications (Counsellors)

EGM Modification

Mean Effectiveness

Score(SE)

Item Rank

N


1 20 ( 20) 40 5

Paying out in cash instead of tokens

1 40 ( 25) 39 5

Increasing time elapsed between initial bet and outcome (e g , 2 5 to 5 sec reel spin)

1 60 ( 25) 36 5 5

Paying out in cash instead of tickets

1 60 ( 40) 36 5 5

Increasing minimum bet size 1 60 ( 40) 36 5 5


1 60 ( 40) 36 5 5

Decreasing the chances of a win occurring (e g , 25% to 5%)

1 80 ( 37) 34 5

Reducing volume of sound effects (e g , music and ringing)

2 00 ( 45) 32 5 5

Decreasing game variety on a machine

2 00 ( 55) 32 5 5

�5


TABLE 16 Most Effective EGM Modifications (Problem Gamblers)

EGM Modification

MeanEffectiveness

Score(SE)

Item Rank

N

Eliminating electronic fund transfers at the EGMs e g , direct debit

4 00 ( 41) 1 11

Requiring mandatory registration/use of smart card to begin play

3 73 ( 41) 2 11

Delaying immediate access to large wins (i e , paying out large wins in the form of cheques)

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

Displaying machine activity in cash value instead of credits

3 08 ( 29) 9 12

Removing bill acceptors from EGMs

3 08 ( 38) 9 12

Eliminating bonus rounds (e g , further play on a different game with different features)

3 08 ( 36) 9 12

TABLE 17 Least Effective EGM Modifications (Problem Gamblers)

EGM Modification

Mean Effectiveness

Score (SE)

Item Rank

N

Increasing minimum bet size 1 25 ( 13) 40 12


1 55 ( 21) 39 12


1 67 ( 26) 37 11

Paying out in cash instead of tickets

1 67 ( 26) 37 12


1 67 ( 28) 37 11

Decreasing the chances of small wins occurring

1 73 ( 27) 35 12


1 83 ( 30) 34 12


1 91 ( 39) 33 12


1 92 ( 26) 32 11


2 00 ( 28) 31 12

�6


that would be most effective in reducing problem gambling. All Key Informant groups generally believed that the most ef-fective modifications were mandatory registration/smart card use, eliminating direct electronic fund transfers at EGMs, re-quirement 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 modifica-tions were also found between the Key Informant groups. These are reported in Table 18, which shows the quartile ranking (i.e., 1-�) 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 effec-tive 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., pay-ing 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 oth-er three Key Informant groups.


For this analysis, �6 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 clus-ter stands out completely from the rest; rather, a gradual in-crease 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., elimi-nating 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 reduc-ing 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 chang-es to payout methods, betting options, and problem/responsible gambling messaging on the machine.

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

EGM ModificationQuartile Ranking by Key Informant Group

Researchers Specialists CounsellorsProblem Gamblers

Removing bill acceptors from EGMs 1 1 2 1


2 2 2 1


2 2 2 1


2 3 2 1

��


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


Effectiveness Score(95% CI)

Controls on Money Spent

- 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

3 42 (3 09-3 75)N = 38

Payment Methods

- 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

3 28 (2 92-3 64)N = 39

Controls on Time Spent

- 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

2 80 (2 49-3 12)N = 38

Speed of Play- Increasing time elapsed between initial bet and outcome (e g , 2 5 to 5 sec reel spin)- Remove player controlled stop button

2 58 (2 25-2 90)N = 39


- Hiding spinning reels from player’s view- Eliminating advertising of big prizes on machines

2 53 (2 19-3 01)N = 39

EGM-based RGFs

- 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

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- Reducing maximum bet size- Increasing minimum bet size- Decreasing # of lines on which one can bet (e g , 5 to 2 lines)

2 18 (1 94-2 42)N = 39

Problem Gambling Help Messaging

- Providing on-screen Helpline number and message- Providing Helpline number and message on the back of printed payout ticket

2 11 (1 83-2 39)N = 37

Payout Methods

- 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

2 06 (1 75-2 37)N = 39


- 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 99 (1 76-2 21)N = 39

�8


No statistically significant differences were found using an ANOVA to compare the four Key Informant groups’ indi-vidual 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 attractive-ness 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 Gambling1) 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 re-port 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 effective-ness scores for each of the 25 items ranged from �.00 to 1.��. 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 modifica-tions, as judged by the Researchers, included prohibiting ac-cess to funds from credit cards at ATMs (M = �.00), removing ATMs from the casino gaming floor (M = �.85) or the casino completely (M = �.62), and prohibiting the cashing of cheques at venues (M = �.85). Moreover, restrictions on alcohol also made the top quartile.

In terms of the evidence to support venue modifications, ap-proximately 6�% 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 prohib-iting access to funds from credit cards at ATMs (2�.1%) and prohibiting the service of alcohol at EGMs (2�.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.

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

Venue Modification

Mean Effectiveness

Score (SE)

Item Rank

N


NWeak

%Moderate

%Strong

%

Prohibiting access to funds from credit cards at ATMs

4 00 ( 32) 1 13 53 8 23 1 23 1 13

Removing ATMs from the casino gaming floor

3 85 ( 39) 2 5 13 33 3 41 7 25 0 12

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

�9


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

Venue Modification

Mean Effectiveness

Score (SE)

Item Rank

N


NWeak

%Moderate

%Strong

%

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.��) or pro-viding 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 market-ing would be very effective (M = 2.�� and M = 2.�2, respec-tively). Other items that rated low with this group were pro-viding non-gaming entertainment on site (M = 1.92) and plac-ing EGMs in a highly visible location in the facility (M = 2.2�). 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.

50


Specialists’ Opinions. Specialists were asked to assess the ef-fectiveness 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 �.�5 to 1.6�. The modifications that the Specialists believed to be most effec-tive 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 = �.�5), 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 �.50. Removing ATMs from the casino and providing a self-exclusion program also made the top quartile.

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 modi-fications. With the exception of providing self-exclusion pro-grams, 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 2� on the next page.

As the table shows, the modifications that received the low-est mean effectiveness scores by the Specialists were reducing

the number of EGMs in a facility (M = 1.6�) and capping the number of EGMs in a facility (M = 1.6�), followed by prohibit-ing prize advertising at gaming venues (M = 1.�5). 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.

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

Venue Modification

Mean Effectiveness

Score (SE)

Item Rank

N


NWeak

%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

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

51


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

Venue Modification

Mean Effectiveness

Score (SE)

Item Rank

N


NWeak

%Moderate

%Strong

%

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

52


Counsellors’ Opinions. Counsellors were asked to assess the effectiveness of 20 venue modifications. Their mean ef-fectiveness scores ranged from �.50 to 1.80. The items that the Counsellors believed to be most effective are presented in Table 2�.

As can be seen in the table, the most effective venue modifi-cation according to the Counsellors was providing self-exclu-sion programs (M = �.50). They also believed that restricting EGMs to dedicated gaming venues (M = �.20), limiting access to ATMs through daily withdrawal restrictions (M = �.20), de-nying funds from credit cards at ATMs (M = �.20), and allow-ing only one ATM withdrawal per venue visit (M = �.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 non-gaming entertainment on site (M = 1.80). The next lowest items all had identical scores of 2.60. The items were: reduc-ing 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 �.�2 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 �.0. These included prohibiting cheque-cashing at venues (M = �.�2), restricting daily ATM withdrawal amounts (M = �.25), allowing only one ATM withdrawal per venue visit (M = �.25), removing ATMs from the casino altogether (M = �.18), and prohibiting access to funds from credit cards at ATMs (M = �.09). The items that the Problem Gamblers believed to be the least effective are presented in Table 2�.

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 pro-viding other non-gaming entertainment attractions on site (M = 2.�5) and restricting EGMs to dedicated gaming venues (M = 2.�5) as being less effective than the other modifications. Lastly, providing self-exclusion programs (M = 2.6�) and win-dows in gaming rooms (M = 2.��) were also rated among the least effective venue modifications.

TABLE 24 Most Effective Venue Modifications (Counsellors)

Venue Modification

Mean Effectiveness

Score(SE)

Item Rank

N

Providing a self-exclusion program

4 50 ( 29) 1 4

Restricting EGMs to dedicated gaming venues (casino, racetrack)

4 20 ( 37) 3 5

Restricting daily ATM withdrawal amount

4 20 ( 37) 3 5


4 20 ( 49) 3 5

Allowing only one ATM withdrawal per venue visit

4 00 ( 45) 5 5

TABLE 25 Least Effective Venue Modifications (Counsellors)

Venue Modification

Mean Effectiveness

Score(SE)

Item Rank

N


1 80 ( 49) 20 5

Reducing the number of EGMs in a facility

2 60 ( 81) 17 5

Capping the number of EGMs in a facility

2 60 ( 81) 17 5

Displaying time of day in gaming room

2 60 ( 68) 17 5

Providing windows in the gaming room

2 60 ( 75) 17 5


2 60 ( 68) 17 5

5�


TABLE 26 Most Effective Venue Modifications (Problem Gamblers)

Venue ModificationMean

EffectivenessScore (SE)

Item Rank

N

Prohibiting the cashing of cheques at venue

4 42 ( 29) 1 12


4 25 ( 35) 2 5 12


4 25 ( 35) 2 5 12

Removing ATMs from the casino

4 18 ( 38) 4 11


4 09 ( 44) 5 11

TABLE 27 Least Effective Venue Modifications (Problem Gamblers)

Venue Modification

Mean Effectiveness

Score (SE)

Item Rank

N


1 91 ( 39) 20 11


2 45 ( 41) 18 5 12


2 45 ( 46) 18 5 11


2 67 ( 41) 17 11


2 73 ( 45) 16 11

5�


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 rank-ings across all Key Informant groups regarding the most effec-tive 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 cheque-cashing 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 ef-fective for reducing problem gambling risk were providing windows or displaying time of day in gaming rooms, provid-ing non-gaming entertainment on site, and placing EGMs in a highly visible location in the facility. Table �0 on the next page shows some notable similarities and differences be-tween 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

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

Venue ModificationQuartile 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



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

55


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



Restricting daily ATM withdrawal amount 2 2 1 1


2 3 1 1

Providing a self-exclusion program 3 1 1 4

Establishing patron information & education initiatives in venue

4 2 2 2

56


self-exclusion programs very highly (i.e., in the 1st quartile), while the Researchers and Problem Gamblers rated it in the �rd and �th quartiles, respectively. Second, although patron information and education initiatives in the venues received a relatively high 2nd quartile ranking by the Specialists, Counsellors, and Problem Gamblers, the Researchers ap-peared to be significantly less enthused about its effective-ness, as they ranked it in the bottom quartile.


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 �1.

As can be seen from the table, all clusters had similar the-matic mean effectiveness scores, based on confidence inter-val 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 rat-ing than the other clusters had alcohol amenities not been included. That is, using a cluster consisting of only restric-tions on ATM and cheque-cashing conveniences would have a significantly higher thematic mean score (M = �.��; CI: �.�0-�.1�) as compared to the rest of the clusters.

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


Importance Score(95% CI)

Venue Conveniences

Removing ATMs from the casino






Prohibiting access to free alcohol

Prohibiting the service of alcohol at the EGM

3 61 (3 27-3 96)N = 38

Venue-based Harm Minimization Strategies



Conducting venue staff training

2 95 (2 58-3 31)N = 38

EGM Accessibility



Prohibiting venues from being open 24 hours/day

2 77 (2 37-3 16)N = 38

Venue TypeProviding non-gaming entertainment on site

Restricting EGMs to dedicated gaming venues

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


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..

5�


Using ANOVA to compare the four Key Informant groups’ thematic mean effectiveness scores, no statistically signifi-cant differences emerged, which suggests that there was a general consensus in views across all four groups regarding the general effectiveness of venue modifications for mitigat-ing 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 Gambling1) 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 presen-tation of the most and least effective modifications as iden-tified 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.

Researchers’ Opinions. The range of mean effectiveness scores for the Researchers was �.69 to �.08, although the first four items had fairly close scores. Results are presented in Table �2.

As shown, Researchers thought that the most effective com-munity accessibility modification was limiting concentration of EGMs in low income neighbourhoods (M = �.69) and re-stricting EGMs to destination style gaming facilities away from residential populations (M = �.62). These were followed by centralizing EGMs to one or a few locations (M = �.5�), and reducing (M = �.�6) and capping (M = �.08) the number of EGM facilities in a community.

In terms of evidence strength, at least �0% 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 fa-cilities in a community, and capping the number of EGM facili-ties 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 (5�.8%) and restricting EGMs to destination style gaming facilities away from residential populations (�6.2%). The weak support for this latter modification is notable given that Researchers considered it to be one of the more effective modifications.

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

Community Accessibility ModificationMean Effectiveness

Score (SE)


NWeak

%Moderate

%Strong

%

Limiting concentration of EGMs in low income neighbourhoods

3 69 ( 31) 38 5 30 8 30 8 13

Restricting EGMs to destination style gaming facilities, away from residential populations

3 62 ( 29) 46 2 38 5 15 4 13

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

58


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 �.00 to 2.�8. These scores were generally lower than those of the Researchers. Results are presented in Table ��.

As seen in the table, the item considered to be most effective by Specialists was restricting EGMs to destination style gam-ing facilities away from residential populations (M = �.00). Reducing the number of EGM facilities and centralizing EGMs to one or a few locations had the next highest mean effective-ness scores (M = 2.6� each, respectively). The Specialists thought that the least effective modifications were limiting concentration of EGMs in low income neighbourhoods (M = 2.��) and capping EGM facilities in a community (M = 2.�8).

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 desti-nation style gaming facilities, away from residential popula-tions; limiting concentration of EGMs in low income neigh-bourhoods; 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 (�.80 to 2.00) of all the Key Informant groups. Results showing their mean effectiveness scores and standard errors are reported in Table �� on the next page.

As the table shows, the most effective modification accord-ing to the Counsellors was centralizing EGMs to one or a few locations (M = �.80). The next most effective modifica-tions were reducing and capping the number of EGM facilities in a community, which both had a mean score of �.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 popu-lations (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 �.�5 to �.��. The results are presented in Table �5.

As can be seen, the most effective modifications according to Problem Gamblers were capping the number of EGM facilities in a community (M = �.�5) and reducing the number of EGM facilities in a community (M = �.��). The least effective modi-fication was centralizing EGMs to one or a few locations (M = �.��). 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.

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

Community Accessibility ModificationMean Effectiveness

Score (SE)


NWeak

%Moderate

%Strong

%


3 00 ( 46) 57 1 42 9 0 0 7

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


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

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The item rankings of community accessibility modifications for each Key Informant group are reported in Table �6.

As indicated in the table, no one community accessibility modification emerged as the consensus choice for most ef-fective 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 gener-ally 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 residen-tial 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 �, 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-

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

Community Accessibility ModificationItem Ranking by Key Informant Group



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

TABLE 34 Community Accessibility Modification Effectiveness (Counsellors)

Community Accessibility Modification

Mean Effectiveness

Score(SE)

N

Centralizing EGMs to one or a few locations

3 80 ( 58) 5

Reducing the number of EGM facilities in a community

3 00 ( 84) 5

Capping the number of EGM facilities in a community

3 00 ( 84) 5


2 20 ( 74) 5


2 00 ( 55) 5

TABLE 35 Community Accessibility Modification Effectiveness (Problem Gamblers)

Community Accessibility Modification

Mean Effectiveness

Score (SE)

N


3 75 ( 37) 12


3 73 ( 45) 11


3 58 ( 43) 12


3 50 ( 42) 12


3 33 ( 45) 12

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tiveness. Thus, in general, all groups thought that reducing the number of EGM facilities and centralizing EGMs to one-or 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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3 FOCUS GROUPS WITH PROBLEM GAMBLERS

METHODOLOGY

Two focus groups with EGM Problem Gamblers were con-ducted for this study, both by Dr. Jamie Wiebe of Factz Research. One focus group was held in Regina, Saskatchewan (N = �); 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, � were female, 5 were male. Most were between �0 and 50 years of age (Mean = 52; Range = ��-�5).

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 frame-work 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 approxi-mately 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 GamblingIn 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 gam-bling 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 GamblingAll participants felt that there were specific features associated with EGMs that contributed to problems. Commonly men-tioned 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 in-crease 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 black-jack. 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 GamblingParticipants were asked whether there were features specific to the EGM gaming venue that they felt contributed to prob-lems. A few talked about the excitement and exhilaration cre-ated 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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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 ex-perienced large wins the first few times they played slot ma-chines 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 men-tioned 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 partici-pant 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 GamblingAll participants felt strongly that increased community accessi-bility 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 GamblingParticipants were asked what modifications to EGMs they thought would help reduce problems. This produced a va-riety 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 over-stimulating with all of the lines. It would be boring with just

� 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 pre-determined spending limits. Some felt that money should be displayed on an EGM in dollars and cents, rather than cred-its. 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 infor-mation 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 GamblingWhen 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 com-mon 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 infor-mation 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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Community Accessibility Modifications to Reduce Problem GamblingIn 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 par-ticipants, however, felt that removing EGMs from residen-tial areas would help prevent problems, but would not help those with problems already: “Problem gamblers will gamble anywhere.”

The Importance of PreventionOverall, 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 spend-ing 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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4 DISCUSSION

The present study reviewed the literature and synthesized the opinions of a cross-section of Key Informants via ques-tionnaires and focus groups. A number of findings emerged which identified potential EGM-related contributors to prob-lem 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, commu-nity accessibility features) are reviewed below, followed by a discussion of the study’s limitations.

FINDINGS

EGM Features

ContributorsWith 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), in-volve faster payment methods (e.g., bill acceptors), and give the appearance of near-misses were rated much higher in im-portance 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.

ModificationsSince Key Informants identified direct electronic fund trans-fers 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 gam-bling risk. The general consensus among Key Informants regarding direct electronic fund transfers is particularly in-

teresting, 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 mini-mization strategies.

The finding that Key Informants identified removing bill ac-ceptors as an effective method to reduce problem gambling risk is supported by studies from the literature review show-ing that a significant number of problem gamblers report of-ten or always using bill acceptors as compared to non-prob-lem gamblers.�8, �9

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 poten-tial 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-con-trolled 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 man-datory registration and use of the cards, while the study from Australia suggested that rather than help manage spending, card-based technologies might actually facilitate it. 6�, 68

From a broader perspective, the thematic analysis indicated that Key Informants believed that modifications to limit ac-cess 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 chang-ing participants’ experience of the game and more in impos-ing 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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and satisfaction 22, 2�-25 and was not an important harm mini-mization 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 mea-sures 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 rela-tively low ratings to restrictions on betting options, but high-er ratings to reducing speed of play and the appearance of near-misses.

Venue Features

ContributorsAccording 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, 2�-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 dis-sociation, 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.

ModificationsAlthough there was relatively less consensus among the four Key Informant groups about the most effective venue modi-fications to reduce problem gambling risk, prohibiting access to funds from debit and credit cards, disallowing cheque-cashing at venues, and removing ATMs from the casino al-together were generally seen to be among the more effective measures. This fits somewhat with the findings in the litera-ture that support placing bans on credit card cash advances and removing ATMs from the gaming floor.�5, �9 It is clear that in addition to removing ATMs, there was considerable sup-

port among Key Informants for introducing other forms of ATM restrictions. These included tighter controls over with-drawal limits which, again, was supported by research in the literature. �9

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 ineffec-tive for displacing problem gambling behaviour.

Community Accessibility Features

ContributorsOverall, 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 gen-erally rated all of the community accessibility features higher than did the Specialists.

ModificationsIn terms of relative rankings, there was considerable varia-tion 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 lo-cations would be the most effective community accessibility modification. Consistent with their views on the most signif-icant contributors to problem gambling, the Researchers and Specialists supported the centralization of EGMs in fewer fa-cilities, away from residential areas, as the best way to reduce problem gambling risk.

LIMITATIONSThere 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,

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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 de-veloped 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 fo-cusing 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 gam-blers were conducted for this study, it is generally ideal to conduct at least four to six in order to increase the likeli-hood that saturation will be reached (i.e., that all novel ideas and opinions will be generated by participants).11� 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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5 SUMMARY & CONCLUSIONS

On behalf of the Saskatchewan Liquor and Gaming Authority (SLGA), the Responsible Gambling Council (RGC) conduct-ed 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 �2 Key Informants, includ-ing 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 EGM-related 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, particu-larly 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 prac-tical, 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 util-ity, findings must be interpreted within a jurisdiction’s socio-political, geographic, and economic context.xviii

The framework for this report, derived from the literature, fo-cused 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 cer-tain 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 agree-ment 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 prob-lem 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 im-portant. 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 MoneyThroughout 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-cash-ing, 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 modi-fications across the Key Informant groups related to the re-striction of player access to funds; that is, restricting direct electronic fund transfers that involve any use of credit or deb-it cards—either on EGMs or on portable machines that can

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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) sys-tems 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 ac-tual gambling session. There was considerable Key Informant support in the present study for the general creation of pre-commitment 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 TechnologyThe 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 elab-orate 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, op-tional/mandatory features, type and level of enforcement), Key Informants would, undoubtedly, have varying views on the breadth and comprehensiveness of such systems.

Restricting Community AccessWhile 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 ac-cessibility modifications relatively high, though, making it difficult to clearly identify a single modification as being no-tably more effective than the others.

Other Notable Observations

Strength of EvidenceBoth 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 evi-dence, 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 uncov-ered in the literature review.

EGM-based InducementsThere 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 prob-lem gambling, they did not get enough attention as modifica-tions 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 MessagesRankings related to responsible gambling messages on ma-chines or in venues appeared in the mid-range of the themat-ic rankings. This would suggest that there is reasonable sup-port for such messages, but little confidence that they would have a large influence on problem gambling.

ConclusionTaken 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 relation-ship 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 fur-ther 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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22. Loba, P., Stewart, S. H., Klein, R. M., & Blackburn, J. R. (2001). Manipulations of the features of stan-dard video lottery terminal (VLT) games: Effects in pathological and non-pathological gamblers. Journal of Gambling Studies, 1�(�), 29�-�20.

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APPENDIX 1: KEY INFORMANTS

A total of 69 Key Informants from across Canada and abroad were asked to participate in this study. They in-cluded: 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, opera-tors,) identified through gambling governing bodies and/or personal referral; �) problem gambling Counsellors, iden-tified through addiction agencies in Saskatchewan and Ontario and/or personal referral; and �) 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,ProjectCo-coordinator,DalhousieGamblingLab,DepartmentofPsychology,DalhousieUniversity.

Brian Cox,Professor,DepartmentsofPsychiatryandPsychology,UniversityofManitoba.

Shawn Currie,Researcher,AlbertaGamingResearchInstitute.

Jeffrey Derevensky,DepartmentofEducationalandCounsellingPsychology,McGillUniversity.

Harley Dickinson,Professor,DepartmentofSociology,UniversityofSaskatchewan.

Katharine Diskin,PhDCandidate,Universityof

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,DepartmentofPsychology,UniversityofCalgary.

David Korn,Professor,DepartmentofPublicHealthSciences,UniversityofToronto.

Robert Ladouceur,Professor,DepartmentofPsychology,UniversitéLaval.

Tracy Schrans,OwnerandVicePresident,FocalResearchConsultantsLtd.

Garry Smith,GamblingResearchSpecialist,AlbertaGamingResearchInstitute,FacultyofExtension,UniversityofAlberta.

Sherry Stewart,Professor,DepartmentofPsychology,CommunityHealthandEpidemiology,DalhousieUniversity.

Tony Toneatto,ResearchScientist,CentreforAddictionandMentalHealth.

Nigel Turner,ResearchScientist,CentreforAddictionandMentalHealth.

Jamie Wiebe,President,FactzResearch.

Robert Williams,Professor,SchoolofHealthSciences,UniversityofLethbridge.

Harold Wynne,President,WynneResources.

American

Bo Bernhard,AssistantProfessorofSociology,UniversityofNevada,LasVegas.

Robert Breen,AssociateDirector,RhodeIslandGamblingTreatmentCentre.

Mark Dixon,AssociateProfessor,BehaviorAnalysisandTherapyprogram,RehabilitationInstituteofSouthernIllinoisUniversity.

Lia Nower,AssistantProfessorofSocialWelfare,UniversityofMissouri.

Rachel Volberg,President,GeminiResearchLtd.

Jeffrey Weatherly,DepartmentChair,DepartmentofPsychology,UniversityofNorthDakota.

Mark Zimmerman,AssociateProfessor,DepartmentofPsychiatryandHumanBehavior,BrownUniversity.

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International

Alex Blaszczynski,Professor,SchoolofPsychology,UniversityofSydney.

Peter Collins,ProfessorandDirector,CentrefortheStudyofGambling,UniversityofSalford.

Paul Delfabbro,SeniorLecturer,SchoolofPsychology,UniversityofAdelaide.

Mark Dickerson,Professor,SchoolofPsychology,UniversityofWesternSydney.

Nicki Dowling,SchoolofPsychology,PsychiatryandPsychologicalMedicine,MonashUniversity.

Mark Griffiths,Professor,DivisionofPsychology,NottinghamTrentUniversity.

Nerilee Hing,AssociateProfessor,SchoolofTourismandHospitalityManagement,SouthernCrossUniversity.

Charles Livingstone,SeniorResearchFellow,AustralianInstituteforPrimaryCare,LaTrobeUniversity.

Jan McMillan,Professor,CentreforGamblingResearch,AustralianNationalUniversity.

Michael O’Neil,Director,TheSouthAustralianCentreforEconomicStudies.

Louise Sharpe,SeniorLecturer,DirectorofClinicalResearch,SchoolofPsychology,UniversityofSydney.

Michael Walker,SeniorLecturer,SchoolofPsychology,UniversityofSydney.

SPECIALISTS

Health and Problem Gambling Professionals

Canadian

Steve Christensen,ProgramConsultant,CommunityCareBranch,SaskatchewanHealth.

Sharon Jackson,ProblemGamblingProgramManager,WalterThorpeRecoveryCentre.

Gerry Kolesar,Supervisor,ProblemGamblingServices,AddictionsFoundationofManitoba.

Kyle Prettyshield,ProgramManager,FirstNationsAddictionRehabilitationFoundation(Saskatchewan).

Robert Simpson,ChiefExecutiveOfficer,OntarioProblemGamblingResearchCentre.

Bill Ursel, Director,ProblemGamblingUnit,CanadianMentalHealthAssociation.

American

Keith Whyte,ExecutiveDirector,NationalCouncilonProblemGambling.

International

Mark Henley,Manager,AdvocacyandCommunication,UnitingCareWesleyAdelaide.

Regulators

Canadian

Donna Klingspohn,Manager,BritishColumbiaProblemGamblingProgram.

Elizabeth Stephenson,Director,Research&Communications,ManitobaGamingControlCommission.

Kent Verlik,Director,SocialResponsibility,MinistryofGaming(Alberta).

International

Linda Woo,ExecutiveDirector,LicensingandGamingServices,QueenslandOfficeofGamingRegulation.

Operators

International

Rob d’Hondt,ManagerandSeniorTrainer/Consultant,d’HondtTraining&Consultancy,Hulst,TheNetherlands.

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PROBLEM GAMBLING COUNSELLORS

Saskatchewan

Cathy Dickson,PrinceAlbertParklandRegionalHealthAuthority.

Don Ozga,RegionalHealthAuthority,ReginaQu’Appelle.

Barb Papp,SaskatoonRegionalHealthAuthority.

Ontario

Evelyn Bakich,SisterMargaretSmithCentre.

Rachel Fraser,AddictionsAssessmentServicesofOttawa-Carleton.

Janine Robinson,CentreforAddictionandMentalHealthProblemGamblingService.

Lisa Root,NiagaraAlcohol&DrugAssessmentService,GamblingSupportServices.

Randy Uyenaka,PinewoodCentreofLakeridgeHealth.

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APPENDIX 2: KEY INFORMANT QUESTIONNAIRE

The Responsible Gambling Council (RGC) would like to learn more about the relationship between EGMs and problem gam-bling 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 �, 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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SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING

Thefollowingisacompilationofsomeofthekeyfeaturesofelectronicgamingmachines(EGMsi.e.,slotsandvideolotteryterminals),venues,andaccessibilityfactorssaidtocontributetoproblemgambling.Inyouropinion,usingthe5-pointscaleprovided,pleaseindicatetheimportanceofeachfeatureasacontributortoproblemgambling.

In your opinion, how important are the following factors as contributors to EGM-related problem gambling?

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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


1 2 3 4 5

80


80


No

t at

all

Imp

ort

ant

Slig

htl

y Im

po

rtan

t

Mo

der

atel

y Im

po

rtan

t

Very

Im

po

rtan

t

Extr

emel

y Im

po

rtan

t

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)

1 2 3 4 5

Offering winning outcomes less frequently through a lower “hit-rate” (i e , lower chances of a win occurring)

1 2 3 4 5

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

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

81


81


No

t at

all

imp

ort

ant

Slig

htl

y Im

po

rtan

t

Mo

der

atel

y im

po

rtan

t

Very

Imp

ort

ant

Extr

emel

y im

po

rtan

t

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

82


82

SECTION A: OPEN-ENDED QUESTIONS

ReferringtoSectionA,pleaselistthetopthreemostimportantEGMfeatures,EGMVenuefeatures,andCommunityAccessi-bilityfeaturesthatyouthinkmostlikelycontributetoproblemgambling.Forinstance,ifyouthinkthatsoundeffectsaretheEGMfeaturethatmostlikelycontributestoproblemgambling,indicatethisasyourfirstchoice,andthenpleaseexplainyourreasoningforyourselection.

50) EGM Features

First

Second

Third

PleaseindicateanyotherEGMfeature,not listed in Section A,thatyouthinkisanimportantcontributortoproblemgam-bling.Pleasealsoexplainyourreasoningforspecifyingthisadditionalfeature.

51) EGM Venue Features

First

Second

Third

PleaseindicateanyotherEGMVenuefeature,not listed in Section A,thatyouthinkisanimportantcontributortoproblemgambling.Pleasealsoexplainyourreasoningforspecifyingthisadditionalfeature.

52) Community Accessibility Features

First

Second

Third

PleaseindicateanyotherCommunityAccessibilityfeature,not listed in Section A,thatyouthinkisanimportantcontributortoproblemgambling.Pleasealsoexplainyourreasoningforspecifyingthisadditionalfeature.

8�


8�

SECTION B: EGM/VENUE/ACCESSIBILITY MODIFICATIONS

IthasbeensuggestedthatanumberofmodificationstoEGMs,thevenuesthathousethem,andtheiroverallaccessibilityinthecommunitymayhelpreducetheriskofproblemgambling.Usingthe5-pointscaleprovided,pleaseindicatehoweffectiveyouthinkeachmodificationwouldbeinreducingthisrisk.Also,usingthe3-pointscale,pleaseindicateyouropinionofhowstrongtheevidenceistosupporttheeffectivenessofeachmodificationinreducingthisrisk.

MODIFICATIONS

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?

No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

EGM


1 2 3 4 5 1 2 3

Increasing time between the outcome of one bet and the next bet (i e , slowing play)

1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

Eliminating sound effects and music

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

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

8�


8�

MODIFICATIONS




No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

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¢)

1 2 3 4 5 1 2 3

Decreasing # of lines on which one can bet (e g , 5 to 3 lines)

1 2 3 4 5 1 2 3

Eliminating advertising of big prizes on machines

1 2 3 4 5 1 2 3

Eliminating frequent presentation of big prize symbols shown during play (e g , reel placement)

1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

Decreasing game variety on a machine

1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

Removing player controlled stop button

1 2 3 4 5 1 2 3

Showing only the relevant outcome combinations

1 2 3 4 5 1 2 3

Hiding spinning reels from player’s view

1 2 3 4 5 1 2 3

Displaying simultaneous (as opposed to sequential) presentation of reel outcomes

1 2 3 4 5 1 2 3

85


85

MODIFICATIONS




No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

EGM


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

Decreasing the chances of small wins occurring

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


1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

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


1 2 3 4 5 1 2 3

86


86

MODIFICATIONS




No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

EGM


1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

Providing general information about responsible gambling on welcome screen

1 2 3 4 5 1 2 3

Providing on-screen Helpline number and message

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

8�


8�

MODIFICATIONS



In your opinion, how strong is the evidence

supporting the effectiveness of each

modification in reducing problem gambling risk?

No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

EGM 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

Restricting EGMs to dedicated gaming venues (EGM site, racetrack)

1 2 3 4 5 1 2 3


1 2 3 4 5 1 2 3

Displaying time of day in gaming room

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

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

Eliminating targeted player marketing for EGMs

1 2 3 4 5 1 2 3

Reducing targeted player marketing for EGMs

1 2 3 4 5 1 2 3

88


88

MODIFICATIONS



In your opinion, how strong is the evidence

supporting the effectiveness of each

modification in reducing problem gambling risk?

No

t at

all

effe

ctiv

e

Slig

htl

y ef

fect

ive

Mo

der

atel

y ef

fect

ive

Very

eff

ecti

ve

Extr

emel

y ef

fect

ive

Wea

k

Mo

der

ate

Stro

ng

EGM VENUE

Eliminating general gambling marketing

1 2 3 4 5 1 2 3

Reducing general gambling marketing

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

1 2 3 4 5 1 2 3

Prohibiting venues from being open 24 hours/day

1 2 3 4 5 1 2 3

Restricting EGM play-time hours in venue

1 2 3 4 5 1 2 3

Providing a self- exclusion program

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


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

89


89

SECTION B: OPEN-ENDED QUESTIONS

PleaselistthetopthreemodificationstoEGMs, Venues,andCommunity Accessibilitythatyouthinkwouldmostlikelyreduceproblemgamblingrisk.Forexample,ifyouthinkthatreducingspeedofplayisthemostimportantEGMfeaturetochange,pleaseindicatethisasyourfirstchoiceandthenpleaseexplainyourreasoning.

129) EGM Features

First

Second

Third

PleaseindicateanyotherEGMfeaturemodification,not listed in Section B,thatyouthinkwouldmostlikelyreduceEGM-relatedproblemgamblingrisk.Pleasealsoexplainyourreasoningforspecifyingthisadditionalfeaturemodification.

130) Venue Features

First

Second

Third

PleaseindicateanyotherEGMvenuemodification,not listed in Section B,thatyouthinkwouldmostlikelyreduceEGM-re-latedproblemgamblingrisk.Pleasealsoexplainyourreasoningforspecifyingthisadditionalvenuemodification.

131) Community Accessibility Features

First

Second

Third

PleaseindicateanyotherEGMaccessibilitymodification,not listed in Section B,thatyouthinkwouldmostlikelyreduceEGM-relatedproblemgamblingrisk.Pleasealsoexplainyourreasoningforspecifyingthisadditionalmodification.

90


90

Venue Specific Harm Minimization Strategies

Inthespaceprovidedbelow,pleasedescribeyourthoughtsregardinganyimprovementsyoumightmaketotheself-exclusionprogram,patroninformationandeducationinitiatives,andstafftrainingprograms.Forexample,youmaywanttodescribewhyyoudonotthinkthattheadvertisingoftheself-exclusionprogramiseffectiveandwhatyouwouldsuggesttomakechanges.

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

HealthandProblemGamblingSpecialist CDN INT

ProblemGamblingResearcher CDN INT

Regulator CDN INT

Operator CDN INT

91


91

APPENDIX 3: OPEN-ENDED RESPONSES TO QUESTIONNAIRE

Key Informants who participated in this study (i.e., Re-searchers,Specialists,Counsellors,andEGMProblemGam-blers) were asked to complete a comprehensive question-naireregardingEGM-relatedproblemgambling(Appendix2).Aspartofthequestionnaire,someKeyInformants(i.e.,Researchers and Specialists) were asked to answer supple-mental,open-endedquestionsabout the factors that couldeithercontributeto,orminimize,problemgambling.Topicsexploredintheseopen-endedquestionsrelevanttothepres-entreportinclude:

• Additionalfeaturesthatmightcontributetoproblemgamblingnotalreadymentionedinthequestionnaire(i.e.,EGMfeatures,venuefeatures,communityaccessibilityfeatures),and

• Additionalmodificationstotheabovefea-turesthatmightreduceproblemgamblingrisknotalreadymentionedinthequestion-naire.

TheresponsesgivenbytheResearchers(N=13)andSpe-cialists(N=12)totheopen-endedportionofthequestion-nairearepresentedbelow.

Additional EGM Features That Contribute to Problem Gambling

- Sound/visualeffectstestedon-siteinvenues,ratherthaninlaboratoriesRxx

- ContinuousplayR

- Linked jackpotscanencouragea‘feeding frenzy’whenthoughtclosetoapayoutlevelR

xx R = Researchers; S = Specialists

- ‘Freespin’featuresonAustralian-styleEGMsappeartobestronglyrelatedtoplaypatternsofproblemgamblersR

- Featuresencouragingplayerstobetmore,suchas‘buy’features/bonuses,couldleadplayerstoincreasebetsizeespeciallyiftheoptionispresentedduringagameS

- Overallissueofgamedesign,mapping,anddisplayreelsneedstobeevaluatedcloselybygovernmentregulatorsS

- Pop-upmessages,theabilityofplayerstosettheirowntime and money limits, machine setting time limits,trackingspending/losses,easyaccesstoonscreenprob-lemgambling/responsiblechoicemessages,informationaboutcostperhourS

Additional Venue Features That Contribute to Problem Gambling

- Gambling areas that can be accessed directly from carparksandthestreet,asplayerscanthenaccessgamblinginsecretS

- EGMs secluded in quiet corners of gaming establish-mentslimitinteractionwithothersincludingstaffS

- VenueswithEGMsasamajor facility, i.e.,venues thatgenerateahighproportionofincomefromEGMsversusotherentertainmentfacilitiesandrecreationaloptionsR

- PromotionsthatrequirethepatrontowaitalongtimeinthevenuebeforewinnersareannouncedencourageslongergamblingsessionsR

Additional Community Accessibility Features That Contribute to Problem Gambling

- Over-concentrationofEGMinlowincomeneighbour-hoodsmaybeundesirableasthisneedstobebalancedagainstthefactthatlowincomeearnersmayhavelimit-edopportunitiesforsocialinteractionandhavingenter-tainmentfacilitieslocatedintheirneighbourhoodmaybepositiveforthatcommunityS

- Traditionally government would be responsible forregulation, enforcement and consumer protection.However,inmostjurisdictionsthathaveallowedEGMs,thegovernmentshaveeitherbecometheoperator,pro-moter, and a major beneficiary of gaming operations.Thisappearstohavecompromisedtheirpreviousroles.Thegovernmentpromotionandsanctioningofgaminghasledtoanincreaseingamingactivitiesthatperhapswould not have been there had the government takenamoreenforcementroleandamorepublic safetyap-proach.S

92


92

- ‘Fit’betweencommunitiesandaccessibilitytoEGMs.Wehaveevidencethatsomecommunitiesaremoreresilientthanothers,withgreatercapacitytominimisegamblingharm. Conventional socio-demographic-economic in-dicatorsarenotpredictors.R

- FreebusestogamblingvenueswhichincreaseaccessR

- Thereisnotterriblystrongevidencethatproblemgam-bling is more so an issue for low income individuals.StatsIamfamiliarwithnotemoderatetohigherincomepersonswithproblemgamblingbehaviour.S

Additional EGM Modifications to Reduce Problem Gambling

- Controloverlosslimitsbycalibratingthecentralsystemsothatplayerscouldlosenomorethan$50ina48hourperiodR

- Modifications to make the game unappealing, e.g., aninter-trial interval of greater than 15 seconds (averagereelspinspeed3.5-5.0seconds;playersplayatarateofonespinper10seconds)R

- Someofthefeaturemodificationsidentifiedinthissur-vey have interactions, e.g., increasing speed of play byitself may have minimal effect if number of lines andbetlevelsarekeptatexistinglevels.However,iftheyareraisedatthesametime,thecombinationcouldleadtoproblematicbehavioursS

- RemoveorrestrictlinkedjackpotsR

- EliminationoffreespinfeaturesR

- Photo-recognition imbedded in machines to enforcevoluntaryself-exclusionS

Additional Venue Modifications to Reduce Problem Gambling

- GamingareasshouldbefullyintegratedintothefacilityandlocatedprominentlyinvenuessogamblerscannothideawayandgambleinsecretS

- Nocreditorcheque-cashingprivilegesR

- Usingsmartcardswithpre-setlimitsandnoplayuntildebtispaidS

- Encourage operators to be receptive and involved inplayerinformation/protectionmeasures.Settinganex-ampleat the topmakes it easier for employees toem-braceandimplementsoftinterventiontechniques.Thiscouldbeaccomplishedviaregulatoryinterventionifop-eratorsarenotreceptive.S

- Saskatchewan Gaming Corporation has developed the

I-care system, which is a responsible gaming trackingsystembasedonplayerwageringbehaviour.ThissystemwhichistransferabletoallEGMsystemsandvenues,ifcombinedwithasmartcardsystem,wouldappeartobeahighlyeffectivesysteminreducingrisksS

- Reducing ATM access might have unpredictable re-sults.Itmightcausepeopletoaccessmoremoneyaheadof time because they know they can’t access it at thecasinoR

- Eliminatingtargetedadvertisementsisabitofaproblembecauseitwouldbepossibletoavoidmarketingtoprob-lemplayersS

Additional Community Accessibility Modifications to Reduce Problem Gambling

- Theissueofaccessibilitywilldifferfromcommunitytocommunity and it is necessary to understand the dy-namicsofindividualcommunitiestobetrulyeffective.S

- If the emphasis is on prevention I think you need toprovide informationandmessagingoutsideofgamingvenues. By the time people have decided to play theyarenotinterestedinRGorPGmessages.Don’tconfuseresponsiblegamblingmessageswithproblemgamblingmessages.Givepeoplesomeguidelinesbywhichtoas-sesstheirplay.WorkdonebyDavidHodginsisveryin-teresting in this regard.Work on early education withyouthaboutdangersofovergambling.S

- Prohibitionmaybeworththinkingabout-particularlyiftherearenumerousotherlessriskygamblingoptionsavailable. EGMs are clearly the most dangerous gam-blingmode!R

- reducingthenumberofEGMsinacommunityS

9�


9�

APPENDIX 4: COMPLETE RANKINGS OF CONTRIBUTORS AND MODIFICATIONS

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

EGM ContributorItem Rank Order

Researchers 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


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

9�


9�

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

Venue ContributorItem Rank Order


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 ContributorItem Rank Order


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

95


95

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

EGM Modification

Item Rank Order by Key Informant Group



1 2 5 1

Removing bill acceptors from EGMs 2 4 14 5 9


3 5 1 1 2

Require mandatory registration and use of smart card to begin play

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


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


11 5 17 36 5 21 5

Enforcing play stoppage, break or interruption 11 5 10 27 23 5


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


22 5 30 34 20

96


96

EGM Modification



Toning down lights and colours 25 33 27 12


25 25 5 7 5 19

Displaying time of day on screen 25 34 40 37


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


30 5 21 5 27 33

Add responsible gaming button leading to gambling information screens

30 5 39 5 36 5 37

Paying out in cash instead of tokens 34 5 19 5 27 25 5


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

34 5 38 39 37


37 5 33 36 5 34

Provide Helpline number and message on the back of printed payout ticket

37 5 21 5 27 39

Increasing minimum bet size 39 39 5 36 5 40


40 31 5 19 5 32

(Table A4 continued from previous page)

9�


9�

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

Venue Modification



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


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


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

98


98

APPENDIX 5: FOCUS GROUP SCRIPT

Two focus groups with EGM problem gamblers were con-ducted for this study: One in Regina, Saskatchewan (N = �), the other in Ajax, Ontario (N = 8). A description of the focus groups’ methodology and results are presented in Chapter �. 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 gam-bling 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 pro-viding your answers during the focus group, please try to be as open, frank, and detailed as you can.

WARM UP QUESTIONS

1. Canyoutellmeabitaboutyourgamblinghistory?

a. Howlonghaveyoubeengambling?

b. Whydidyoustartgambling?

c. HowlongwereyouplayingEGMsbeforeyoufeltthatyouhaddevelopedaproblem?

d.. When you first started gambling, what form ofgamblingdidyoudo?

e. Areyoucurrentlygambling?

MAIN QUESTIONS

2. CanyoutellmeabitaboutyourexperiencewithVLTsandslotmachines?

a. Whyareyoudrawntothesemachinesoverother

formsofgambling?Whatisitaboutthemachinesthatappealstoyou?

b. WhatisitaboutVLTsandslotmachinesthatmakethemsoproblematic?Whydoyouthinkthis?Forexample, some people think that their speed ofplay isproblematic.<<Can PROMPT with other examples (see questionnaire)>>

c. IfyoucouldchangeanythingaboutVLTsorslotmachines to make them less problematic, whatwouldyouchange?

d. Do you think that VLTs and slot machines aremoreproblematicthanotherformsofgambling?Ifso,howwouldyoudescribethedifference?

3. Canyoutellmeaboutthegamingvenuesyou’veat-tended?

a. Whyareyoudrawntothem?Whatisitaboutthevenues that make gambling more appealing toyou?

b. Is there anything about the gaming venue thatmakesgamblingmoreofaproblemforyou?Ifso,what is it? For example, some people think thathavinga largenumberofEGMsata siteplaysalarge role. <<Can PROMPT with more examples (see questionnaire)>>

c. If you could change anything about the gamingsite tomakegambling lessofaproblemforyou,what would you change and how would you dothis?

4. CanyoutellmeabitabouttheavailabilityofVLTsandslotmachinesinthecommunity?

a. Howdoyouthinktheavailabilityofthemachinesaffectsyourgambling?Whydoyouthinkthis?Forexample, some people believe that having VLTsandslotmachineslocatedclosetoresidentialareascanbeaproblem.

<<Can PROMPT with more examples (see questionnaire)>>

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b. Ifyoucouldchangeanythingabouttheavailabil-ityofVLTsorslotmachinesinyourcommunity,whatwouldyouchange?

5. Whatdoyouthinkgamingvenuescoulddotoeffec-tivelyaddressEGM-relatedproblemgambling?

6. WhatistheonethingthatyouthinkwouldbemosteffectiveinreducingtheriskofEGM-relatedproblemgambling?<<If they suggest things that are unrealistic or impractical, PROMPT for next best option>>

7. Haveyoueverself-excludedfromagamingvenue?

a. Describe the effectiveness of the program. Canyouidentifyanysuccessesyou’vehadorchallengesthatyou’vefaced?

b. Overall, did it help you ad-dress your gambling problems?<<Can PROMPT: Why or why not? >>

8. WhenyoufirststartedusingVLTsorslotmachines,didyouknowabouttheriskofproblemgambling?

9. Doyoufeelthatifyouhadbeenawareofrisk,itwouldhavereducedthelikelihoodofyoudevelopinggambling-relatedproblems?

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APPENDIX 6: COUNSELLOR INTERVIEWS

METHODOLOGY

Eight problem gambling counsellors from addiction agen-cies participated in interviews for this study: five from Saskatchewan, three from Ontario. Interviews were con-ducted in-person or over the telephone by Dr. Jamie Wiebe and lasted approximately one hour. Some of the topics cov-ered during the interviews of relevance to the present report include:

• Counsellingexperienceandclientele,

• PerceivedEGMfeatures,EGMvenuefeatures,and community accessibility features thatcontributetoproblemgambling,

• Perceivedmodificationstotheabovefeaturesthat might reduce EGM-related problemgamblingrisk,and

• Preventionstrategies.

The script that was used by the interviewer to guide the in-terviews is presented in Appendix �. The names of the coun-sellors 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 � to �2 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 re-lated to EGMs, with five counsellors indicating that at least 80% of their clients had such problems. All but one counsel-lor felt that the proportion of clients with EGM-related prob-lems had stayed stable over the years; the remaining coun-sellor 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 EGM-related 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 oc-cur. 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 men-tioned 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 play-ers 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 ma-chines was a factor, noting that clients tend to have a prefer-ence 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 ma-chines 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 ap-plied to both casinos and VLT sites. Another common sug-gestion 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 counsel-lor 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 mea-sure, 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

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

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 bet-ter…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 pre-contemplative. 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 gam-bling. 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 win-ning 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 ma-jority 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 be-lieved would not affect problem gambling risk. Most, for in-stance, 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 ma-chines 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 be-cause clients know all about the prizes. Finally, although pro-viding 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.

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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.

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 barsand restaurants; remove EGMs from residentialareas.

- Decrease access to money:RemoveATMsfromgam-ingvenues.

- Increase control over money spent: Provide smartcards that specify maximum amounts that can bespent;decreasemaximumbets.

- Increase honesty and transparency:Informconsum-ersoftherisks,expectedlossesperhour,andoddsof winning; display machine activity in dollars orcentsratherthancredits.

- Reduce gambling advertising: Manycalled fora re-duction in gambling advertising, with one par-ticipant stating that the“product ismarketed toapoint where we think that gambling circumventsproblems.”

- Raise public awareness of the problems associated with gambling:Oneparticipantnotedthatitisstill“notokaytotalkaboutproblemgamblingpublicly.Peoplesufferalone.Societyneedsmorenormaliz-ingthatproblemsdooccur.”Anotherfeltthatitisimportanttoletpeopleknowthatgamblingcanbecontrolled, thatyoudon’thave toquit inorder togethelp.

- Intervene early: Provide on-site professionals whocan approach players displaying distress or whohavebeengamblingforextendedperiodsoftime.

- Target youth: Participantsnotedtheimportanceofearlyeducationandinformingyouthoftherisksas-sociatedwithgamblingbeforetheyreachlegalage.

- Decrease government involvement: A couple of re-spondentsfeltthatgovernmentshouldnotbeinthegamblingbusiness;thatitsendsmixedmessagesandfacilitatesthebeliefthatgamblingmustbesafe.

- Increase non-gambling options:Havemoresocialal-ternativessothatpeopledon’tviewgamblingastheonlyoptionforsocializingandexcitement.

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APPENDIX 7: COUNSELLOR INTERVIEW SCRIPT

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 work-ing 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. Canyoutellmeabitaboutyourbackgroundasanad-dictionscounsellor?

a. Howlonghaveyoubeenanaddictionscounsellor?

b. How long have you specialized in problemgambling?

c. Isyourcounsellingpracticeexclusivelyforproblemgambling?

2. Canyoutellmeaboutyourclientele?

a. What proportion of your clientele present withgamblingproblems?

b. WhatproportionofthisgroupareEGMusers?

c. Has the proportion of EGM users changed overtime, if so,has it increasedordecreased?Howdoyouaccountforthechange?

MAIN QUESTIONS

Basedonyourexperienceandwhatyouhavelearnedthroughcounsellingproblemgamblers…

3. CanyoutellmeabitaboutEGMs?

a. What is it about the machines that make themproblematic? Why do you think this? For exam-ple,somepeoplethinkthattheirspeedofplayisaproblem.<< Can prompt with other examples (see questionnaire)>>

b. IfyoucouldchangeanythingaboutEGMstomakethemlessproblematicforyourclients,whatwouldyouchangeandhowwouldyoudothis?

c. Do you think that EGMs are more problematicthanotherformsofgambling,suchascasinotablegames?Ifso,whatmakesyouthinkthis?

d. Doyouthinkyourclientswouldsharetheseviewswithyou?

4. Canyoutellmeabitaboutthegamblingvenue(i.e.,casino,barswithEGMs)?

a. Isthereanythingaboutthevenuethatmakesgam-blingmoreofaproblemforyourclients?Ifso,what?Forexample,somepeoplethinkthathavingalargenumberofEGMsatasiteplaysalargerole.<< Can prompt with other examples (see questionnaire)>>

b. Ifyoucouldchangeanythingaboutthegamingsiteto make gambling less of a problem for your cli-ents,whatwouldyouchangeandhowwouldyoudothis?

c. Doyouthinkyourclientswouldsharetheseviewswithyou?

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5. CanyoutellmeabitabouttheavailabilityofEGMsinthecommunity?

a. HowdoyouthinktheavailabilityofEGMsinyourcommunity plays a role in problem gambling foryourclients?Whydoyouthinkthis?Forexample,some people believe that having EGMs locatedclosetoresidentialareasisproblematic.

<< Can prompt with other examples (see questionnaire)>>

b. Ifyoucouldchangeanythingabout theavailabil-ityofEGMsinyourcommunity,whatwouldyouchange?

c. Do you think your clients would share this viewwithyou?

6. WhatdoyouthinkisthebestthingagamingvenuecoulddotoeffectivelyaddressEGM-relatedproblemgambling?

a. WhatdoyouthinkistheBESTthingagamingven-uecando?

7. Whatareyourthoughtsontherolethatself-exclusionplaysinhelpingpeoplewiththeirgamblingproblems?

a. Inyourexperience,hasthistypeofprogramhelpedyourclients?Ifso,how?

b. Canyouthinkofanybenefitsand/orlimitationstotheself-exclusionprogram?

c. What do you think your clients would say abouttheusefulnessofself-exclusionasawaytorecoverfromproblemgambling?

8. DoyouthinkthatifyourclientshadbeenawareoftheincreasedriskofproblemgamblingrelatedtoEGMs,itwouldhavereducedtheirlikelihoodofdevelopingproblems?

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

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