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      Prevention paradox logic and problem gambling: Does low-risk gambling impose a greater burden of harm than high-risk gambling?

      , 1 , * , 1

      Journal of Behavioral Addictions

      Akadémiai Kiadó

      gambling, prevention paradox, harm, risk

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          Abstract

          Background and aims

          The aim of this paper is to examine the evidence and arguments in favor of prevention paradox (PP) logic in the context of problem gambling. Evidence from recent studies of gambling and the distribution of harm across lower and higher risk gamblers is reviewed to examine the contention that the absolute burden of harm is greater in low-risk (LR) gamblers than the problem gamblers.

          Methods

          The review examines a number of methodological and conceptual concerns about existing evidence in support of the PP.

          Results

          The principal problems identified include the misclassification of LR gamblers; the use of binary scoring method that understates the frequency of harms in high-risk populations; a tendency to confuse behavior and harm; and the use of potentially overly inclusive definitions of harm with low thresholds of severity.

          Discussion and conclusions

          This paper makes a number of recommendations for enhancement of this area of research, including the use of clear definitions of harm and LR behavior and a greater focus on harm with material impacts on people’s quality of life.

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          Most cited references 16

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          The Strategy of Preventive Medicine

           G. ROSE,  G Rose,  G Rose (1992)
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            Gambling and the Health of the Public: Adopting a Public Health Perspective.

             A. Korn,  J Shaffer (1998)
            During the last decade there has been an unprecedented expansion of legalized gambling throughout North America. Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gambling-related problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;3. Outline the major public health issues about how gambling can affect individuals, families and communities;4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.
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              The extent of the 'prevention paradox' in alcohol problems as a function of population drinking patterns.

              To assess to what extent use of various criteria for high-risk groups and analyses from subpopulations with different drinking patterns may affect the extent of the prevention paradox (that most alcohol-related harm in populations arises within the drinkers at low risk). Data sets Two national surveys of Norwegian adult samples (n = 4321 current drinkers) and one register linkage of Swedish armed forces conscripts (n = 45 839 current drinkers) with in-patient hospital data. High-risk groups were categorized as the upper 10% of drinkers by annual alcohol intake or by intoxication frequency. Acute alcohol-related harms comprised number of quarrels and fights in the Norwegian surveys and number of hospital admissions for attempted suicide and violent injuries over a follow-up period (3 and 25 years) in the Swedish conscript study. The majority of acute alcohol problems were found among the majority of drinkers with low or moderate risk (the lower 90%) by drinking volume, suggesting empirical support for the prevention paradox. By applying frequency of intoxication rather than annual volume of consumption to determine the high-risk group, a somewhat larger proportion of acute alcohol-related harms was found within the high-risk group, and the number of alcohol-related harms tended to be distributed more evenly between high-risk drinkers and other drinkers. The proportion of alcohol-related harms within the risk groups was significantly lower in the younger age group, where the majority drinks to intoxication compared with other drinkers. The extent of the prevention paradox with respect to acute alcohol problems may be more prominent in drinking in subpopulations where intoxication is a common part of the drinking pattern compared with those where intoxication occurs less frequently and among a smaller fraction of the drinkers.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                19 April 2017
                June 2017
                : 6
                : 2
                : 163-167
                Affiliations
                [ 1 ]School of Psychology, University of Adelaide , Adelaide, SA, Australia
                Author notes
                [* ]Corresponding author: Paul Delfabbro; School of Psychology, University of Adelaide, North Terrace, Adelaide, SA, Australia; Phone/Fax: +61 8 8313 4936; E-mail: Paul.delfabbro@ 123456adelaide.edu.au
                Article
                10.1556/2006.6.2017.022
                5520119
                28425779
                © 2017 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
                Funding
                Funding sources: None.
                Categories
                REVIEW ARTICLE

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