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      Gambling with Your Health: Associations Between Gambling Problem Severity and Health Risk Behaviours, Health and Wellbeing

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          Abstract

          The current study examined the association between gambling problem severity and health risk behaviours, health and wellbeing. A cross-sectional survey (including representative population and supplementary convenience samples) was conducted with 2303 adult residents of a British Island. Gambling problem severity was assessed using the Problem Gambling Severity Index. The EQ-5D-5L, WEMWBS and AUDIT-C were used to measure general health, mental wellbeing and alcohol use, respectively. Other measures included diet, physical exercise and tobacco use. Differences between gambling severity levels for each measure were analysed using logistic regression adjusting for age, sex and income. Compared to non-problem gamblers, moderate/high severity gamblers had higher odds of a poor diet, low physical exercise and poor general health. Tobacco use was associated with both low and moderate/high severity gambling. Low severity, but not moderate/high severity gambling, was significantly associated with binge and higher risk drinking behaviours. Health risk behaviours tended to cluster, with a graded relationship between gambling problem severity and odds of reporting at least two health risk behaviours. Compared to non-problem gamblers, low severity gamblers were approximately twice as likely and moderate/high severity gamblers were three times as likely, to have low mental wellbeing. Findings suggest associations between gambling problems and a range of health risk behaviours and health issues, and crucially that such issues are not limited to gamblers with the highest severity of problems. Addressing gambling across the whole continuum of risk should be a key public health priority.

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          Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey

          Background The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed to meet demand for instruments to measure mental well-being. It comprises 14 positively phrased Likert-style items and fulfils classic criteria for scale development. We report here the internal construct validity of WEMWBS from the perspective of the Rasch measurement model. Methods The model was applied to data collected from 779 respondents in Wave 12 (Autumn 2006) of the Scottish Health Education Population Survey. Respondents were aged 16–74 (average 41.9) yrs. Results Initial fit to model expectations was poor. The items 'I've been feeling good about myself', 'I've been interested in new things' and 'I've been feeling cheerful' all showed significant misfit to model expectations, and were deleted. This led to a marginal improvement in fit to the model. After further analysis, more items were deleted and a strict unidimensional seven item scale (the Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS)) was resolved. Many items deleted because of misfit with model expectations showed considerable bias for gender. Two retained items also demonstrated bias for gender but, at the scale level, cancelled out. One further retained item 'I've been feeling optimistic about the future' showed bias for age. The correlation between the 14 item and 7 item versions was 0.954. Given fit to the Rasch model, and strict unidimensionality, SWEMWBS provides an interval scale estimate of mental well-being. Conclusion A short 7 item version of WEMWBS was found to satisfy the strict unidimensionality expectations of the Rasch model, and be largely free of bias. This scale, SWEMWBS, provides a raw score-interval scale transformation for use in parametric procedures. In terms of face validity, SWEMWBS presents a more restricted view of mental well-being than the 14 item WEMWBS, with most items representing aspects of psychological and eudemonic well-being, and few covering hedonic well-being or affect. However, robust measurement properties combined with brevity make SWEMWBS preferable to WEMWBS at present for monitoring mental well-being in populations. Where face validity is an issue there remain arguments for continuing to collect data on the full 14 item WEMWBS.
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            Should addictive disorders include non-substance-related conditions?

            In anticipation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to consider whether addictive disorders should include non-substance use disorders. The author reviewed data and provided perspective to explore whether disorders such as pathological gambling (PG) should be grouped together with substance dependence, given that they share many features. PG and substance dependence currently reside in the DSM, fourth edition, text revision (DSM-IV-TR) within separate categories, with PG classified as an impulse control disorder (ICD) and substance dependence as a substance use disorder (SUD). Arguments can be forwarded to support each categorization, as well as to justify their inclusion together as addictions. The current state of knowledge suggests that there exist substantial similarities between PG and SUDs. Further research is indicated prior to categorizing PG and other ICDs together with SUDs.
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              Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

              To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria. The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p .05). Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.
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                Author and article information

                Contributors
                n.l.butler@ljmu.ac.uk
                Journal
                J Gambl Stud
                J Gambl Stud
                Journal of Gambling Studies
                Springer US (New York )
                1050-5350
                1573-3602
                8 November 2019
                8 November 2019
                2020
                : 36
                : 2
                : 527-538
                Affiliations
                [1 ]GRID grid.4425.7, ISNI 0000 0004 0368 0654, Public Health Institute, , Liverpool John Moores University, ; 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP UK
                [2 ]Department of Health and Social Care, Public Health Directorate, Douglas, Isle of Man
                Author information
                http://orcid.org/0000-0002-4938-7870
                Article
                9902
                10.1007/s10899-019-09902-8
                7214382
                31705379
                4569f10f-75eb-4a02-9949-3d1dc93bfa1c
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Original Paper
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                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                Health & Social care
                problem gambling,health,smoking,alcohol,diet,exercise
                Health & Social care
                problem gambling, health, smoking, alcohol, diet, exercise

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